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LIBRARY OF CONGRESS, 



Chap.:„:..._ Copyright So 
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UNITED STATES OF AMERICA. 



TYPHOID FEVER 



AND ITS 



ABORTIVE TREATMENT 



JOHN ELIOT WOODBRIDGE, Ml D. 

Member and Ex-President Mahoning County, Ohio, Medical Society, 
Member and Ex-Vice-President Ohio State Medical Society, 
Member of Mississippi Valley Medical Association, 
Member of Ninth International Medical Congress, 
And Member and Trustee American Medical Association, 
Etc., Etc. 



ALL RIGHTS RESERVED. 










Cleveland : 

L. Leavengood and Company, 

No. 48 The Arcade. 

1896. 






Copyright, 1896, 

By John Eliot Woodbridge, M. D. 

Registered at Stationer's Hall, 

London, England. 



"Thus, for me, as in the case of great physicians, the 
measure of real progress in medicine must not, and should 
not, be estimated in any other way than the greater or lesser 
number of patients which the physician can conscientiously 
say he has seized out of the jaws of death." 



No matter in what position in life a man may be, his 
greatest object should be to preserve health and life." 

— Semmn'ia. 



CORRIGENDA. 



Page 20. Third line from foot of page— insert or before typho-malanal. 

Page 85. Twelfth line of first paragraph-for respectful read respectable. 

Page 93. Fourth line of fourth paragraph-for but read and. 

Page 102. Eighth line from top-in place of (hey read the symptoms. 

Page 101. Fourth line of second paragraph-for insufficient read inefficient. 

Page 1 14 Fifth line from foot of page— omit which. 



PREFACE. 

The objects that are sought to be accomplished by 
the issuance of this book are : First, to present to the 
members of the medical profession so much evidence 
of the truth of the " startling- declaration that typhoid 
fever can be aborted" as will induce a large number of 
physicians to give antiseptic medicine a fair and faithful 
trial in this disease — the most destructive to adolescent 
life of all of the acute specific infections — a disease which 
is both preventable and curable, but which is not only 
not excluded from, but has been practically invited to 
invade every community, and has hitherto been allowed 
to pursue its course uninterrupted by any scientific or 
efficacious treatment ; second, to give such explicit direc- 
tions as will enable all physicians to so intelligently 
apply the principles of antiseptic medicine to the cure of 
typhoid fever that they may secure for their patients the 
least inconvenience and suffering, the shortest duration 
of illness, and the lowest possible death rate ; third, and 
finally, to impress upon the minds of the members of this 
medical profession the enormity of the crime which is 
committed by all communities that pour their excrement 
laden sewage into our fresh water lakes and rivers, in 
violation of all sanitary principles, of genuine humane- 
ness and even of common decency ; to the subversion 
of all efforts at the prophylaxis of typhoid fever, cholera, 
and other diseases. 

The book is written in defiance of the opinions of 
the bacteriologist, who has demonstrated the impossi- 



2 PREFACE. 

bility of destroying- the bacillus typhosis in living man ; 
of the pathologist, who has shown that the microorgan- 
ism finds its way deep into all of the organs of the body, 
and hence cannot be dislodged ; of- the therapeutist, 
who has asserted that drugs can accomplish no useful 
purpose in the treatment of typhoid fever ; and of the 
theorist^ who has exposed the ignorance of those who 
believe in the curability of the disease. 

The bootless task of endeavoring to demonstrate 
the manner in which these antiseptic medicines pro- 
duce their effects, or the settling of other moot ques- 
tions, has not been essayed ; but these pages will show 
that for more than fourteen years I have had no death 
from typhoid fever in a locality in which my death rate 
had previously been very high — that in no instance in 
which a case of typhoid fever has come under my care 
prior to the eighth day of illness have I failed to abort 
the disease in ten or twelve days or less — that in no in- 
stance in which I have been called so early that a reason- 
ably positive diagnosis could not be made on the first 
or second visit, have I had a well-developed case of ty- 
phoid fever, although many such cases have presented 
pathognomonic symptoms of the disease, and they will 
also show that so large a number other physicians have 
demonstrated the power of abortifacients over typhoid 
fever, that, as an ex-President of the Ohio State Medi- 
cal Society said in a public address (see page 161) "it 
(the treatment) has stood the crucial test for years in 
hundreds of cases and the theory is fully sustained by 
the long list of victories achieved." 

It is to be hoped, therefore, that the importance of the 
subject to both physicians and their patients, will justify 
the haste which sent the book from the printer to the 



PREFACE. 3 

electrotyper without waiting to have the page proofs 
returned to me for correction, and that this entrusting of 
the final proof reading to the printers will serve as an 
excuse for any consequent grammatical or typographical 
defects which may mar its pages. 

637 Prospect Street, Cleveland, Ohio. 
March 10, 1896. 



INTRODUCTION 



It has been my intention to publish this book ever since 
1893, when I first began to keep accurate records of all cases 
presenting pathognomonic symptoms of typhoid fever, 
that I might be able to show a few specimens of the 
evidence of the effectiveness of alexipharmic medicine 
which had convinced others and satisfied myself that 
I had made a discovery — that typhoid fever can be 
aborted and need not necessarily run its usual course — 
and the treatment capable of accomplishing this result, 
which if it were promptly accepted by the entire body of 
the medical profession, and its principles intelligently ap- 
plied to the cure of microbic diseases would greatly abbre- 
viate the duration of the illness, signally ameliorate the 
pathema, and save the life of every victim of typhoid fever, 
as well as minimize the danger from many other diseases. 

It would have been written long ago had not my 
announcement that typhoid fever could be aborted been 
met by such an unanimous expression of disagreement, 
and such impassioned denunciations, as to admonish me 
to beware of the storm clouds gathering above the horizon, 
for every day a new cautionary signal was hoisted, and 
forewarned and thus forearmed I realized that the 
medical profession was not yet ready to accept a theory 
which was not only guilty of the offense of being new 
and in conflict with the most advanced ideas of pathology, 



6 INTRODUCTION. 

but which greatly multiplied the responsibilities of those 
who treat any of the microbic diseases. 

This reason no longer holds good, because so large 
a number of the most conservative physicians of so 
many different localities have succeeded in aborting so 
great a number of cases of typhoid fever that my theory 
has become a principle established by the evidence of 
many observers and that principle at first so universally 
ridiculed and condemned, now governs the practice of 
a large and rapidly increasing number of the most 
intelligent and progressive members of the profession 
and the results which were formerly with unison and 
no hesitation pronounced impossible, are now obtained 
in triumph. 

That which has induced me to take up my pen at the 
present time is the knowledge that I have hitherto 
been able only to give directions for the management 
of the antiseptic treatment of the disease in so brief 
and abridged a manner in my papers (which were 
written in as concise a way as possible that they might 
be finished in the twenty minutes to which each address 
is limited) that many of those physicians, who honestly 
and truly desired to adopt this method of antisepsis, 
were being misled or perverted by my necessarily 
incomplete and hence imperfect and deficient teaching. 
I found that others were wisely awaiting more explicit 
details before attempting to apply so novel a method of 
controlling a pathological condition which had hereto- 
fore been regarded as immedicable. Thus many thou- 
sands of lives were being sacrificed annually to a dis- 
ease which should never cause a death. 

The incompleteness of my work will, perhaps, be 
excused when it is remembered that its paragraphs 



INTR OD UCTION. 7 

have been written in the leisure time between pro- 
fessional engagements, that its preparation has been 
constantly interrupted, and moreover that it has been 
hurried into press, to meet the urgent demand for 
copies, a large number of which were ordered before 
it was even commenced, and that in my haste I may have 
allowed some grave errors to creep into its lines. 

So many wild and unfounded rumors have been cir- 
culated concerning my theories on the subject of intes- 
tinal and general antisepsis, as to require that in justice 
to myself I ought to define my position in unmistakable 
language, that may forestall the future tirades and 
sibilations of those who would castigate and anathema- 
tize, but more especially that my paraphrasts and com- 
mentators may not misunderstand or misjudge me, and 
that my oneirocritics may interpret my dreams of that 
time to come when each human being shall have be- 
come the beneficiary of the publishing of this little book, 
with such acumen and discernment that both physician 
and invalid will be assured of the truthful maxims 
it bears on the white pages between its pasteboard 
covers. 

As I have studied to be brief, no single subject in 
this book has been discussed in all completeness, only 
the more important aspects have been touched upon 
extensively, and I have left much unwritten which 
should have been presented. 

Since many of these pages have been written for 
presentation to widely separated audiences some repeti- 
tion has been necessary and is excusable. 

My statements have been so often misrepresented 
and my position misconstrued, that I may be excused 
for defining my position and claims. 



8 INTR OD UCTION. 

I believe that in every uncomplicated case of typhoid 
fever the disease can be aborted, if proper antiseptic 
treatment be instituted at a sufficiently early stage of the 
malady. 

I have never taught that the disease can always be 
aborted when the treatment has been too long deferred, 
but I have taught that uncomplicated typhoid fever 
should never cause a death — an obvious deduction from 
the first declaration. 

I have never, even by implication, given any one the 
right to assert that I do not recognize the possibility of 
death from intercurrent disease during an attack of 
typhoid fever, even though it may have been properly 
treated from its inception. 

While I have thus far been able to abort the disease 
in every instance in which treatment was instituted on 
or before the eighth day, and in a large percentage of 
those cases in which it was commenced on or before the 
tenth day of sickness, as well as in a few cases taken at 
a much later period, I have never taught that the disease 
can always be aborted when treatment has been so long 
postponed. 

My first modest announcement of some of the advan- 
tages of the antiseptic treatment of typhoid fever made 
in my local society in 1880, was received with such out- 
spoken skepticism and disapproval as to arouse all or 
the latent irascibility in my nature, and if I have occa- 
sionally alluded to the members of the profession, who 
have been accorded every opportunity to see my work 
and who for reasons more or less discreditable refused 
to accept the evidence which they dared not deny, my 
excuse is that the provocation was prodigious. 

I have condemned in unstinted and unmeasured terms 



INTRODUCTION. 9 

those barricades and stumbling- blocks that have cast 
themselves and all of their impediments in the pathway 
of progress. I have maintained that willful ignorance is 
culpable ignorance; that culpable ignorance where human 
life is at stake is a crime, and that he who has an oppor- 
tunity of knowing that the life of every victim of typhoid 
fever can be saved and rejects irrefutable evidence of the 
fact, is guilty of willful ignorance. 

I have denounced with the utmost frankness the 
errors of diagnosis and treatment so commonly and 
habitually made all over the world, wherever this disas- 
trous malady is prevalent. 

In 1882 I declared that intestinal haemorrhage would 
never occur in any case of typhoid fever which had been 
properly treated from the outset of the disease, but I 
have never claimed any special skill in the treatment of 
that accident after its supervention as has been unequivo- 
cally asserted in at least one medical journal by one of 
its associate editors. I shall not waste time in answering 
every diatribist or medical editor who sees something to 
attack or anathematize in everything that does not lie 
within his intellectual horizon. . 

It has been intimated that I have tacitly consented to 
the publication in the secular press of some of my arti- 
cles on typhoid fever. I wish to enter a simple denial to 
this most annoying slander. I have never in all of my 
professional career consented to, or connived at the 
publication in any other than a medical journal of any 
paper or extract from any paper on this or any other 
medical subject. 

All other diatribes and scandals may be left to the 
arbitrament of time. 

The following papers are reproduced here because 



1 IN TR OD UCTION. 

after both the reprints and the editions of the Journal of 
the American Medical Association containing them were 
exhausted and out of print, many requests for copies 
which could not be supplied were received and because, 
having been read before and discussed by various medi- 
cal societies, it is hoped that they may have some weight 
in inducing members of the profession to adopt a prin- 
ciple of treatment in microbic diseases which must con- 
tribute to the longevity of the human race and the 
advancement of the dearest interests and the honor of 
the medical profession. 

My first consideration has been to give such clear 
and explicit details of treatment as would enable every 
intelligent physician to so apply the principles. of the 
abortive treatment of typhoid fever that few lives need 
be sacrificed to this malady. 



TYPHOID FEVER. 



DEFINITIONS. 

The late Dr. Murchison in his classic work, ''Con- 
tinued Fevers, " under the caption ''Enteric or Pytho- 
genic Fever," defines "typhoid fever" as, "An en- 
demic disease, generated and propagated by certain 
forms of decomposing matter. Its symptoms are: A 
commencement often insidious or marked by slight 
rigors, a sensation of chilliness;- a profuse diarrhoea; 
pulse usually frequent and soft, but pulse and temperature 
both subject to great variations in the same patient; 
febril symptoms in mild cases often remittent; tongue 
red and often fissured, occasionally becoming dry and 
brownish; in most cases but not invariably increased 
splenic dullness; tympanitis; abdominal tenderness; 
gurgling in the iliac fossae and diarrhoea with or without 
intestinal haemorrhage; skin warm with occasional sweats. 
An eruption of isolated elevated rose colore spots, 
vanishing on pressure, first appearing between the 
seventh and fourteenth days and coming out in succes- 
sive crops each of which lasts two or three or more days; 
frequently epistaxis; prostration coming on late, patient 
rarely taking to bed before the seventh day; headache 
sometimes followed by stupor and active delirium, but 
mind often clear throughout the attack even in fatal 
cases; dilated pupils; the disease protracted to the 
twentieth or thirtieth day and occasionally though rarely 



12 DEFINITIONS. 

followed by a relapse of all the symptoms including the 
eruption. After death, disease of the solitary and ag- 
minated glands of the ileum and enlargement of the 
spleen and mesenteric glands." 

Hutchinson defines typhoid fever as "An endemic, 
infectious fever, usually lasting between three and four 
weeks, and associated with constant lesions of the soli- 
tary and agminated glands of the ileum and with en- 
largement of the spleen and mesenteric glands. Its 
invasion is gradual and often insidious. Sometimes the 
only symptoms present in the beginning are a feeling of 
lassitude; some gastric derangement and a slight eleva- 
tion of temperature; at others there are slight rigors or 
chilly sensations, headache, epistaxis, diarrhoea, and 
pain in the abdomen. The principal symptoms of the 
fully formed disease are a febril movement possessing 
certain characteristics, headache, passing into delirium 
and stupor, diarrhoea associated with ochre-yellow 
stools, tympanites, pain and gurgling in the right iliac 
fossa, a red and furred tongue, which later becomes dry, 
brown and fissured; a frequent pulse; an eruption of 
rose colored spots, occurring about the seventh or eighth 
day, slightly elevated above the surface, disappearing 
under pressure, and coming out in successive crops, each 
spot lasting about three days; prostration not marked in 
the beginning, but rapidly increasing; and occasionally 
deafness, sweats and intestinal haemorrhages. When re- 
covery takes place, the convalescence is usually tedious, 
and may sometimes be protracted by the occurrence of 
one or more relapses." 

Harley as "A continued febrile condition of uncertain 
duration, accompanied by marked intestinal derangement, 
and invariably associated with lesion of the solitary and 



DEFINITIONS. 13 

agminated glands of the intestines. It commences in 
anorexia, with nausea and vomiting; its progress is 
marked by profuse diarrhoea of light ochre colored 
watery stools, associated with abdominal pains, tender- 
ness and tympanitic swelling; and if the issue be un- 
favorable, it terminates in exhaustion, intestinal haemor- 
rhage, or perforation of the bowel. Death usually occurs 
in the fourth week. In the early period the disease is 
attended by more or less pyrexia; as soon as it is fully 
developed, there is well-marked hectic fever. 

" During the height of the disease a scattered papular 
rash appears in successive crops on the abdomen and 
chest. The rapidity with which the symptoms are mani- 
fested, the degree to which they are developed, vary 
greatly in different cases. The intestinal disease is fre- 
quently obscured by the concurrence of pulmonary or 
cerebral complications." 

Von Gietl — " As a specific, putrid, intoxication disease 
(Intoxications-krankheit) which is composed of a chain 
of diseased processes, which are dependent upon one 
another, but which do not retain a regularity either in 
number or in succession. Its local effect is a catarrh of 
the alimentary canal; the further and peculiar result a 
swelling of the glandular apparatus as well of the mes- 
entary as the mucous membrane of the intestines. 

''Exfoliation and ulceration generally follow, the final 
effects being mortification in all degrees. The lower 
grades of typhoid infection agree perfectly in their mani- 
festations with the simple form of putrid infection." 

These descriptions should be amended, but it would 
be difficult — perhaps impossible — to give an exact defini- 
tion of typhoid fever which would not in the near future 
require emendation; for the signs of the times indicate 



14 DEFINITIONS. 

that we are on the eve of wonderful discoveries in bac- 
teriology which will upset many existing- notions on the 
nature and cure of disease; but since all of these descrip- 
tions of the disease are in a greater or lesser degree 
misleading, some slight improvement on them must be 
attempted. 

Typhoid fever may be loosely described as an acute, 
endemic, infectious fever — which consists of a series of 
pathological changes and anatomical lesions, directly or 
indirectly due to the presence in the system of a specific 
microbic poison. 

These lesions and pathological conditions consist of 
certain changes in the organism, which are dependent on 
the invasion of the various organs of the body by the 
bacteria and the absorption into the circulation of its 
ptomaines. The disease is further characterized by 
many grave and ofttimes fatal complications and sequelae. 
Tumefaction, of an inflammatory nature, of the glands of 
the lower portion of the ileum, the solitary and agmi- 
nated glands of Peyer, or of the glands of the caecum 
or of the colon are constant lesions of the disease and 
unless they regain, as they may, their normal state by 
resolution, necrosis and ulceration follow and from these 
ulcerations intestinal haemorrhage or perforation and 
peritonitis may result. 

The salient pathematic fact around which all minor 
considerations may be grouped is, that the primary 
lesions of the disease are always due to one and the 
same pathogenic influence, probably the bacillus ty- 
phosis and its toxins, that all of its multifarious compli- 
cations and sequelae are deuteropathic consequences of 
the invasion of the system by this poison, that some 
secondary effects are caused by other noxae which have 



NOMENCLA TURE. 1 5 

gained ingress to an organism already weakened by the 
idiopathic disease, or perhaps it were better to say, 
caused in some instances, at least, by the virulization of 
other noxa, already domiciled in the system. Accepting 
this as a true definition of typhoid fever, the obvious de- 
ductions are that stowed away somewhere in the recesses 
of nature is some agent that will neutralize or destroy 
the noxa of typhoid fever, and the logical conclusion is 
that if it can be destroyed in one receptacle it can be 
destroyed in all like receptacles, and as typhoid fever has 
been aborted it can always be aborted. 

When the medical profession realizes that all this is 
possible a new impetus will have been given to the study 
of parasitology and to the relation of this department of 
science to the cure of disease 

nomenclature. 

1. Synonyms Derived from its Supposed Resem- 
blance to Typhus. — Typhus Nervosus, Sauvages, 1760; 
Typhus Mitior and Synochus pro parte, Cullen, 1769; 
Abdominal Typhus and Darm-Typhus, Autenrieth, 1822, 
and German writers generally; Synochus and Typhus 
with Abdominal Affection, Southwood Smith, 1830; 
Fievre Typhoide, Louis, 1829; Chomel,T834; Typhus 
gangliaris vel entericus, Ebel, 1836; Schonlein, 1839; 
Typhoid Fever, Stewart, 1840; Bartlett, 1842; Jenner, 
1849; Mild Typhoid Fever, Copland, 1844; Ilio-typhus 
Griesinger, 1857; Typhia, Farr, 1859; Typhus, many 
writers. 

2. From its Mode of Prevalence. — Febris non- 
pestilens, Forestus, 1591; Endemic Fever, many writ- 
ers; Autumnal or Fall Fever, Flint, 1852; and American 
writers generally. 



1 6 NOMENCLA TURE. 

3. From its Remittent Character. — nvperds 
j)/iirpiiaio$ (?) Hippoc. ; Hemitritseus (?) Tritseophyas 

(?) and Triphodes (?) auctor. antiq. var. ; Febris semi- 
tertiana seu composita, Galen (?) Forestus, 1591; 
Spigelius, 1624; Tritaeophya typhodes Mangetus, 1695; 
Remittent Fever T. Sutton, 1806; Infantile Remittent 
Fever, Evanson and Maunsell, 1836; and many writers. 

4. From its Lengthened Duration.— Febris lenta 
Forestus, 1591; Willis, 1659; Linnaeus, 1763; Vogel, 
1764; Slow or Lent Fever, Strother, 1729; Langrish, 
1735; Febris chronica, (?) Juncker, 1736; Common 
Continued Fever, Armstrong, 1816; Fievre continue 
Lerminier and Andral, 1823. 

5. From its Supposed Nervous or Hysteric Char- 
acter. — Nervous Fever, Gilchrist, 1734; Slow Nervous 
Fever, Huxham, 1739; Febricula, or Little Fever, com- 
monly called the Nervous or Hysteric Fever, Fever on 
the Spirits, Vapours, etc., Manningham, 1746; Irregu- 
lar Low Nervous Fever, Fordyce, 1791; Nervenfieber, 
German writers; Fievre nerveuse, French writers; Low 
Fever, many writers. 

6. From the Occurrence of Putrid or Septic 
Symptoms. — Febris Putrida, Riverius, 1623; Febris 
putrida quae vulgo lenta appellatur, Willis, 1659; Febris 
putrida nervosa, (?) Wintringham, 1752; Febris putrida aut 
biliosa, Tissot, 1758 ; Febris a putredine orta, A. Tral- 
liani, quoted by Burserius as syn. for his Fe. gastric ac, 
1785 ; Febris atacta, proparte, Selle, 1770; Fievre 
ataxique, pro parte, F. adena-meningee, Pinel, 1798; 
Entente septicemique, Piorry, 1841 ; Sepimia, Hare, 
1853. 

7. From its Resemblance to Hectic Fever. — 



NOMENCLA TURE. \ 7 

Febris hectica, Willis, 1667; Infantile hectic fever, 
various writers. 

8. From the Absence of True Typhus- Eruption. 
— Febris petechizans vel spuria, Hoffmann, 1699. 

9. From the Common Occurrence of Gastric 
Derangement, Bilious Vomiting, etc. — Febris gastrica, 
Ballonius, 1640; Febris acuta stomachica aut intestinalis, 
Heister, 1736; Febris glutinosa gastrica, Sarcone, 1765; 
Febris gastrica acuta, Burserius, 1785; Fievre meningo- 
gastrique, Pinel, 1798; Gastrisches Fieber, Richter, 1813; 
Fievre gastrique, Diet, des Sc. med., 1816; Epidemic 
Gastric Fever, Cheyne, 1833; Gastric Fever, Craigie, 
1837; Febris biliosa, Galen (?) River., 1623; Stahl, 1700; 
Juncker, 1736; Bilious Fever, Pringle, 1750; Rutty, 1770; 
Febris biliosa putrida, Selle, 1770; Febbre biliosa, Benelli, 
1775; Synochus biliosus, Sauvages, 1760; Bilio-gastric 
Fever, Copland, 1844; Gastro-bilious and Bilious Con- 
tinued Fever, modern writers. 

10. From the Intestinal Symptoms and Lesions.* 
— Febris colliquativa, (?) J. R. Fortis, 1368, Feb- 
ris stercoralis, (?) Quesnay, 1753; Febris mucosa, 
Selle, 1770; Febris pituitosa, Stoll, 1785; Strack, 1789; 
Febris colliquativa primaria sue essentialis, Burserius, 
1785; Morbus biliosis-mucosus, Knaus, 1786; Febris 
pituitosa nervosa, Jacobi, 1793; Schleimfieber, Kanz, 
1795; Fievre muqueuse, French writers; Mucous or 
Pituitous Fever, Copland, 1844; Febris mesenterica 
maligna, Baglivi, 1696; Hoffmann, 1699; Febris intesti- 
nalis vel mesenterica, Riedel, 1748; Febris mesenterica 
acuta, Burchard, quoted by Burserius, 1785; Fievre 



* Many of the cases described by Cullen and his successor, as "Enteritis 
Erysipelatosa," were probably examples of this fever. (See description of it by 
Alison, 1844, No. 2, p. 323.) 



1 8 NO ME NC LA TURE. 

entero-mesenterique, Petit and Serres, 1813; Enteritic 
Fever, Mills, 1813; Gastro-enterite, Broussais, 1816; En- 
tero-mesenteric Fever, Abercrombie, 1820; Febris 
mesaraica; Wendt, 1822; Dothienenterito, Bretonneau, 
1826; Leuret, 1828; Christison, 1840; Mucoenteritis, vari- 
ous writers; Fever, with Affection of the Abdomen, 
Alison, 1827; Fever with Ulceration of the Intestines, 
Bright, 1829; Gastro-enteric and Gastro-splenic Fever; 
Craigie, 1837; Enterite-folliculeuse, Cruveilhier, 1835; 
Forget, 1841; Enteric Fever, Ritchie, 1846; Wood, 1848; 
W. T. Gairdner, 1859; Coll. Phys., London, 1869; Febris 
tympanica, Babbington, 1853; Intestinal Fever, W. 
Budd, 1856. 

11. From its Supposed Dependence on Worms. — 
Typhus hysterico-verminosus, Sauvages, 1760; Febris 
verminosa, Selle, 1770; Worm Fever pro parte, various 
writers. 

12. From its Mode of Origin. — Night Soil Fever, 
Brown, 1855; Pythogenic Fever, Murchison, 1858; Cess- 
pool Fever, various writers. 

13. Other Designation. — Miliary Fever, Pringle 
and De Haen, 1760.* 

This list of the synonyms of typhoid fever are copied 
from Murchison's great and classic work, " On the Con- 
tinued Fevers of Great Britain," from which I shall have 
occasion to make many extracts, since all authorities 
agree that the late Charles Murchison, M. D., LL.D., 



* Murchison says, "Some of the descriptions of the Greek writers probably 
referred to enteric fever. Hippocrates states that in the course of two successive 
autumns, he met with many cases of fever of the continual type, characterized by 
diarrhoea, offensive watery stools, bilious vomiting, tympanitis, abdominal 
pain, 'red rashes,' epistaxis, sleeplessness, or a tendency to coma, delirium, 
subsultus, irregular remissions, a lengthened duration and great emaciation." 
(De Epid. lib. i. Syd. Soc. Transl. i. 354-9 and 420). 



HISTORY. 19 

F. R. S., should be accredited with having produced the 
best and most accurate treatise that has ever been 
written on these subjects. 

The synonyms are given, not because many of them 
are valuable to-day as designations for this disease, but 
because, dating as some of them do from a period almost 
five hundred years before Christ and some of them pos- 
sibly even antedating that far off time, they in them- 
selves give a cursory history of the disease. 

That this description written in the years intervening 
between the eighty-sixth and ninty-sixth Olympiads re- 
fers to our own typhoid, autumnal fever scarcely admits 
of doubt, nor is it less certain that the " Hemitritaeus " of 
Galen which he believed was compounded "of a tertian 
on a quotidian intermittent and particularly that variety 
designated bilious fever " refers to the same disease. 

Thus the designation of the great Greek physicians 
says as plainly as words could tell it that they regarded 
the disease as of malarial origin. 

Forestus, 1591, in his appellation "febris non peste- 
lens," clearly separates this fever from "typhus," and in 
another name, febris lenta, he tells us that it is a "con- 
tinued fever of long duration." 

In the seventeenth century, Riverius, Willis and 
others, by the names they gave this illness, referred to 
its serious characteristics and give us much information 
of value. 

Again in the eighteenth century, by its many syn- 
onyms, almost every peculiarity of the disease was de- 
scribed, but it was not until the early part of the nine- 
teenth century, 1829, that Louis first gave this pathologic 
state the title by which we now prefer to distinguish it, 
viz., "typhoid fever." 



20 HISTORY. 

A few years later, 1846 et seq., Ritchie and various 
other writers styled the disease "enteric fever," a name 
which has since been adopted by the College of Physi- 
cians of London in its nomenclature of diseases. This 
term is largely used both in England and the United 
States; it is, however, objectionable, since it describes a 
complex disease by one of its pathologic lesions and one, 
too, that does not invariably manifest itself during life 
by any discoverable symptom. 

The most serious misfortune that has occurred to 
thwart and circumvent the recording of each event in the 
history of typhoid fever, was the unfortunate but well- 
meant suggestion of the late Surgeon Woodward, after- 
ward surgeon-general of the United States army, which 
he made in 1862, to give to a supposed complex disease — 
which' cannot exist — the designation of " typho-malarial 
fever." This proposal not only introduced confusion and 
ambiguity into the reports of many army surgeons and 
by so doing greatly impaired the value of the special 
statistics in regard to the two diseases which our noble 
and long-suffering soldiers were infected with during the 
Civil War; but it carried into civilian practice, when 
the army surgeons returned to their hearths and 
homes, a precedent that has ever since been a disturb- 
ing element amongst civil practitioners. It gives 
ignorant and unscrupulous physicians a pretext for 
making a vague and undefinable diagnosis of malarial 
fever, typho-malarial fever, instead of typhoid fever, 
enabling them to apply all of these names to different 
stages of the same malady. 



GEOGRAPHIC DISTRIBUTION. 21 

GEOGRAPHIC DISTRIBUTION. 

The geographical distribution of typhoid fever is 
from the nature of the disease necessarily quite or nearly 
coextensive with the geographical distribution of man. 
In other words, wherever man goes and carries the 
virus of typhoid fever, there will the disease find at least 
a temporary home. It is pre-eminently the serious en- 
demic fever of North America, most parts of Europe, 
India and South America. Africa, Asia and Australia 
have all felt its ravages. Greenland and the frozen 
north, and tropical Mexico make for it an equally agree- 
able abode. Thickly- populated New York, London, 
Paris, Berlin, Vienna, Melbourne, cities of modern times 
with the sanitary science of the nineteenth century at 
their disposal, ancient Rome, and the city of the ever 
changing Nile, Alexandria, that wonderful treasure 
house of the learning and lore of antiquity, Bagdad, 
gorgeous city of the plain, Bombay and Calcutta, cities 
of the Orient, the ice-bound and frigid wayside towns, 
the temporary resting places of the afflicted and'mourn- 
ful exiles to Siberia, our own Washington, the city of 
luxurious private homes and magnificent public institu- 
tions, the capital cities of the old world containing the 
enchanting palaces of their kings, shadowy, etherial 
Venice the bride of the Adriatic, the Phoenix like city of 
the lake, the tropical sea island cities, Havana, Columbo 
and Batavia, the tiny St. Helena and gigantic Australia 
are not exempt from its devastations. The disease 
spreads rapidly from Cape Town to Archangel, and 
from Rio de Janeiro to Sitka. Mecca, with its polluted 
holy wells of the Mohammedan pilgrims, and the 
assemblages at the shrine of Our Lady of Lourdes are 



22 GEOGRAPHIC DISTRIBUTION. 

ready to add their mite to the all destroying virus. The 
city of the mountain with its pure and rarified air and 
that of the low and marshy plain alike are the prey of 
its poison. Patients are found in a Versailles with its 
bizarre contrivances for the unlimited water supply, that 
cool pure water so essential to health ; in a gatchina, of 
an ideal climate, so temperate and regular ; in an Ajuda 
endowed with the crisp and invigorating air of the 
mountain, and in the hovels of the very poor beneath 
their walls, for it recognizes neither poverty nor riches. 
It has found its victims in the very opposite conditions 
of life, amongst the uncivilized Indians of our western 
plains and the rustic natives of Mexico, the pigmy tribes 
and the wild and untamable races of Upper Egypt and 
the Congo — this newly discovered country already has 
it in its midst — and those barbarous savages of Mada- 
gascar are waiting to receive the care and attention as 
well as the medication of civilized medicine. Among 
the hills and rocks of New England, on the adamantine 
and impregnable rock of Gibraltar, on the Rocky Moun- 
tains and in the sunny south, at the mouth of the 
Mississippi and along the mighty Amazon, and the 
merry brook or rill making its way so hurriedly to the 
sea, hurrying and skurrying through meadow and wood, 
past hamlet and village, winding its circuitous course 
by stately mansion and homely homes, but leaving such 
dire disaster in its wake. Peopled continents and iso- 
lated, sparsely populated islands have all alike given it 
domicile. Indeed, there is no people or country that 
has been forever free from its unwelcome presence, and 
no remembrancer would be needed to recall to the mind 
of the poor wretch who had succumbed to its abhorrent 
and tormenting scourges the hell on earth through which 
he has passed. 



CA USES. 23 



CAUSES. 



Predisposing. — Wide as is the geographical range 
of typhoid fever, not less indiscriminate is it in its 
selection of its victims among the human race. Both 
sexes of all nationalities are martyrs, the individual in 
every condition in life, the soldier in bivouac and his 
royal master in the palace, protected by "divine right" 
from all else ; the begger in the street and the million- 
iare in his elysian demesne ; the babe in the cradle and 
his nonagenarian grandsire; all mankind, who have not 
been previously immunized, if equally exposed to the 
poison, are alike susceptible to the disease. All ob- 
servers agree that age exerts a controlling influence 
over typhoid fever. This is probably an error arising 
from several causes. First, very young children are not 
so freely exposed to the action of such pathogenic 
germs as could produce the disease, because the diet 
being principally milk, usually drawn from the mother's 
breast or sterilized, is not apt to give rise to any ill ef- 
fects and being liquid takes the place of other drink, so 
that little water is imbibed. Moreover children residing 
at home with their parents or even in public institutions 
are confined largely to the one locality and soon become 
acclimated to the water they drink and for this reason 
are not so likely to have the disease. For the slow and 
gradual exposure of the organism to the noxious influ- 
ences which cause typhoid fever, does undoubtedly cre- 
ate in the subject a temporary acquired immunity from 
the disease. But instances are not wanting in which 
children have shown their liability to attacks of this dis- 
ease when exposed to its virus. Murchison quotes a 
case as reported by Manzini in which a seven months' 



24 CA USES. 

foetus, which died within half an hour after birth, pre- 
sented lesions of Peyer's glands, and infants have been 
known to die from typhoid fever during the first six 
weeks of life. 

Ernest Hart, editor of the British Medical Journal, 
under the caption of " Water borne Typhoid," reports 
on page 85 of the issue of that journal of the 13th of 
July, 1895, an instance which proves conclusively that 
children possess no special immunity from the disease ; 
it was among the inmates of an institution that the fever 
spread, the immediate cause of the five hundred attacks 
being the chance drinking by some of the orphan 
children of the contents of a stream during one of their 
walks. The stream received the sewage from houses in 
some of which typhoid had occurred, and as a result of 
this consumption, thirty cases cropped up simultaneous- 
ly in the asylum in children having thus drunk of the 
specifically contaminated water. The disease once in- 
troduced, was kept going until five hundred children 
had caught the infection out of some two thousand in 
the asylum. 

Osier, analyzing 229 cases of typhoid fever, treated 
in the medical wards of the Johns Hopkins Hospital, 
gives the following as the ages of the patients : 5 to 
15, 23 ; 15 to 20, 51 ; 20 to 30, 109; 30 to 40, 29; 
40 to 50, 10; 50 to 60, 4 ; 60 to 70, 3. Thus it will 
be seen that nearly 50 per cent of all the cases oc- 
cured in the third decade. 

At from fifteen to twenty years of age, the begin- 
ning of the period of supposed greatest susceptibility, 
lads leave their homes to enter the universities, the 
military or naval academies, or the preparatory schools, 
or to take upon themselves their own support, or it 



CAUSES. 25 

may be to seek a life of pleasure, and they are hence- 
forth exposed to the greatest risk of acquiring- the 
disease. Young maidens are sent to the cities that 
they may receive the advantages of metropolitan life 
or begin their peregrinations about the world in gen- 
eral in search of amusement or to earn their bread, 
and the non-immune constitutions yield readily to the 
strange noxa. 

As one attack gives some immunity against 
typhoid fever, and as there can be no doubt 
but a large percentage of all those who are 
susceptible to the influence or the poison have been 
exposed and many may have had unrecognized or 
abortive attacks during the first half century of life, it 
is hardly necessary to look further for the cause of 
immunity, which has heretofore been accredited to 
age. It is probably true, therefore, that age so uni- 
versally recognized as one of the fruitful predisposing 
causes of typhoid fever, should have no place in that 
category. 

While there is no evidence that general weakness or 
debility or the exhausting effect of other diseases, exerts 
any predisposing influence toward typhoid fever, there 
cannot be the slightest doubt but the poisonous ef- 
fluvia of decaying animal or vegetable matter or of 
human excrement, or that open sewers may so act. On 
the other hand none of these influences can act as excit- 
ing causes of that disease. 

Exciting. — There is but one exciting cause of typhoid 
fever, viz., the invasion of the organism by the noxa of 
the disease, presumably a microbic poison, the bacillus 
typhosis, a water borne virus, the danger from which is 
rendered insignificant by the boiling of all the water and 



26 INCUBATION. 

milk used by the patients for drinking purposes. Oysters 
if laid down in sewage may and no doubt do sometimes 
convey the infection; but sea water is fatal to the ba- 
cillus typhosis, hence the danger from this source must 
be small indeed; besides it is even then but an indirectly 
water borne disease. 

The pathological lesions peculiar to typhoid fever 
are so constant that the conclusion that the disease is of 
azygous origin is fully justified. 

If no uncooked human excrements were eaten or 
drank typhoid fever would be a very rare disease. 

INCUBATION. 

The period of incubation of typhoid fever, as esti- 
mated by different observers, varies between such wide 
limits, that I cannot do better than quote the conclu- 
sions of the Clinical Society of Great Britain, from the 
British Medical Journal of the 20th of July, 1895, em- 
bodied in Dr. Hart's Report on "Water borne Typhoid.'' 

Period of Incubation of Typhoid Fever. — The deliber- 
ations of the Clinical Society on this point are of great 
interest to us in connection with our subject, and it may 
not be out of place if I reproduce their short and pithy 
"Conclusions." (1892). 

"1. The general conclusion to be drawn from all of 
the facts is that the period of incubation of enteric fever 
varies within rather wide limits. The interval between 
exposure to infection and the development of distinct 
symptoms is probably most often twelve to fourteen days. 
It is not very infrequently nine or ten days, occasionally 
eight, and possibly even less. According to Dr. Murchi- 
son, 'it may not exceed one or two days, but no case of 
the kind has been reported to the committee. In rare 



INCUBATION. 27 

cases it has been prolonged to fifteen, eighteen or even 
twenty-three days.' Dr. Murchison thought 'it very 
doubtful if the incubation period ever exceeds three 
weeks.' 

"2. A person suffering from enteric fever is capable 
of conveying the infection to others throughout the 
whole course of the disease, from the date of the earliest 
symptoms of illness until convalescence has been estab- 
lished at least a fortnight. 

" 3. An epidemic due to milk contamination may be 
expected to cease at or about the end of the second week 
after the arrest of the contaminated supply; but an epi- 
demic due to contamination of public water supply may 
not come to an end until the fourth week after the source 
of specific pollution has been removed. Where an epi- 
demic can be traced to well water its duration may be 
very much more prolonged, and no general statement as to , 
the probable date of its spontaneous termination can be 
made. 

"4. Infection can be conveyed by fomites, and re- 
tained in them, probably for two months at least." 

As a peculiar instance of the long period of incuba- 
tion, Dr. Hart mentions as having been put on record by 
Dr. Blaxal "of the Local Government Board." 

"At Fortune's Well, in the isle of Portland, there 
arose an outbreak of typhoid fever in 1886, after an ab- 
sence of fifteen years, the infection being introduced by 
soldiers from Alexandria, four cases developing en voy- 
age, and other six after landing, no one outside of the regi- 
ment being attacked on board. In these latter circum- 
stances it can only be held that infection was derived in 
Egypt, and this being so there comes the fact that the 
period of incubation varied from eighteen to as many as 



28 INCUBATION. 

twenty-five days. Of the outbreak as it affected resi- 
dents near a spring- at Fortune's Well I need not speak; 
the facts in the appendix are clear to all, showing the 
source of the subsequent illness, some eighty cases, to 
have been due to polluted water." 

Dr. Katzenbach, whose opportunity for measuring 
the period of incubation during the epidemic at Bayhead, 
New Jersey, was unusual, estimated that the last of the 
cases (assuming that the milk had been polluted but 
once) had a period of incubation of twenty-nine days, or 
that if Fred J., contaminated the milk the last time that 
he milked the cows then this patient's period of incuba- 
tion was nineteen days. 



CAN TYPHOID FEVER BE ABORTED.* 



The answer echoed and re-echoed from the great 
thinkers of the profession we all love and practice — 
from all over the civilized world — is one prolonged and 
emphatic negative, nowhere more emphatically spoken 
than in the great representative body of American phy- 
sicians, the American Medical Association. 

At its last meeting, in the city of Milwaukee, the 
original papers on typhoid fever, the discussions on 
them, and the editorial comments in the society's journal 
clearly indicate this, and also that the medical profes- 
sion is not at all agreed on its treatment. The most 
divergent methods were advised, some condemned what 
others strongly advocated, these again advising different 
methods, only to be condemned again, and all were 
finally disposed of by the editor of the association jour- 
nal, who under the caption, " The Treatment of Typhoid 
Fever," says, " In the topic which heads this editorial 
the medical profession is certainly as much interested 
as it is in the treatment of pulmonary phthisis. The 
able papers and discussions which we have presented to 
our readers in the columns of this journal, during the past 
few weeks, have been of great value as reflecting the 



*Read before the Mississippi Valley Medical Association, October, 1893. 
Revised 1895. 



30 CAN TYPHOID FEVER BE ABORTED. 

opinions of active practitioners whose practical experi- 
ence is of inestimable service to less favored colleagues; 
yet the fundamental rules governing the management of 
enteric fever are not modified by these expressions of 
opinions. Difference in belief may exist as to whether 
intestinal antisepsis is desirable or obtainable in typhoid 
fever, and whether this temperature or that is to be 
treated as a dangerous symptom, but the important fact, 
that enteric fever is a disease in which good nursing and 
watching are the real factors productive in bringing 
about recovery is universally recognized. In typhoid 
fever, above all other diseases, the physician must recog- 
nize that a cure is impossible, that he can guide the pa- 
tient through the storm but not stop the storm, 
that the only object he may expect to accomplish 
is the control of symptoms which directly or in- 
directly affect the patient unfavorably. While he 
may not be able to remove the cause of the symp- 
toms, the very relief may be advantageous; then a 
delirium indicative of great physical or mental distress, 
or the presence of some complication inducing pain, may 
so exhaust the patient's vitality as to seriously impair 
his chances of recovery; and measures directed to the re- 
lief of these symptoms may save the particles of strength 
needed to carry the case over some crisis in his attack. 
There is, therefore, no specific or routine treatment by 
internal methods which should be resorted to when the 
diagnosis of typhoid fever is established, but there are 
two external methods, aside from feeding, which may be 
applied to so nearly every case as to be called routine, 
namely, absolute rest in bed, flat on the back, and the 
use of the bath in a more or less modified form; a simple 
mixture, designed to maintain free action of the kidneys 



CAN TYPHOID FEVER BE ABORTED. 31 

or stomach may be advised in each case, chiefly to com- 
fort the patient and his friends, but beyond this nothing 
is to be used without a distinct indication by some prom- 
inent symptom. The necessity of absolute rest in early 
stages of enteric fever is known to every one, yet it 
often requires the most strenuous efforts on the part of 
the physician, particularly if he is not aided by a trained 
nurse, to maintain the degree of rest necessary. If there 
is one factor potent in rendering a prognosis unfavorable 
in enteric fever, it is the neglect of this precaution in the 
smallest detail, and every rising to stool may be re- 
garded as a most unfortunate cause of future trouble and 
danger. The use of the bath, or more correctly water 
in any form, during typhoid fever stands next in impor- 
tance and next in its approach to routine. 

"It is a mistaken idea with many physicians that 
' the water treatment of typhoid fever is solelv indicated 
by high fever;' nothing can be more erroneous. While 
high temperature is, without doubt, a most important in- 
dication for the bath treatment, extreme restlessness is 
also a positive reason for its employment. 

"Farther than this, there can be no doubt that the 
use of water not only lowers extreme temperature, but 
prevents its rapid return, and in some way advantage- 
ously modifies nutritional changes. 

"Restlessness and insomnia accompanying fever too 
slight to require the full bath are often entirely relieved 
by a tepid sponging, which soothes the irritated skin 
and equalizes the circulation, refreshing and invigorating 
the patient. Each part sponged should be immediately 
rubbed dry, so that the patient may not be relaxed by 
soaking. We presume this does not apply to the cases 
of high fever, in which friction with the hand must be 



32 CAN TYPHOID FEVER BE ABORTED. 

used to bring the blood to the surface where it may be 
cooled. We have not tried to indicate in this article the 
medicinal treatment required by various complications, 
as space forbids, but we are sure that if these views be 
followed, complications will be less frequent and a firm 
basis maintained for rational measures sometimes neces- 
sary for the relief of accidents." 

These are the expressions of the matured thoughts 
of the members, and of the editor of the journal of that 
association, of which one of the leading medical period- 
icals of Great Britain — a not too partial critic — said 
nearly a quarter of a century ago: "It is probably the 
most learned medical body in the world." 

I do not believe the great American Medical Associ- 
tion has taken any retrograde steps, and I do believe 
that we may accept these opinions emanating from its 
members and from the trusted editor as coming not only 
from the most scientific and cultured medical body, but 
as the expression of the most advanced opinions of the 
highest medical authority in the world. And yet these 
are not extreme views. Everywhere one glances in 
medical literature one sees the same dark and gloomy 
picture of typhoid fever. 

Now and then a new remedy is proposed, or some 
one advances slightly more hopeful views, but he and 
his futile hopes are soon buried in oblivion and his hap- 
less patient in the ground, and no one dares to say that 
the physician ought to or can cure the disease. 

I fully realize the responsibility he assumes, who 
would undertake to criticise adversely the teachings of 
an hundred generations of thinkers. It is said that "old 
beliefs die hard," and the one I propose to endeavor to 
destroy has all the charm of extreme antiquity. Long 



CAN TYPHOID FEVER BE ABORTED. 33 

before typhoid fever was isolated from typhus it was 
taught, as the great scientists of to-day teach, that it can- 
not be cured, but must run its course. Then a new era 
dawned — typhoid fever was recognized as a distinct dis- 
ease, and yet the same theory was promulgated, and in 
almost the same language as is used in the tautology of 
the present day. Time passed ; the medical profession 
made most wonderful strides in the pursuit of knowledge. 
It was found that many diseases — and amongst them 
typhoid fever — were due to or at least were accompanied 
by a germ in some sense peculiar to themselves, and yet 
the same doctrines were again handed down. Let us 
take them up with iconoclastic hands, and see if the piti- 
ful story that typhoid fever cannot be cured may not be 
retold in a more cheerful and encouraging vein. 

On the 17th of July last I read a paper in my local 
society in which I said: "Those of you who were present 
at the meeting of this society held in my office twelve or 
fifteen years since, when this disease (typhoid fever) was 
under discussion, will remember that in criticising a 
paper of one of the members I said: 'While the paper is 
in strict accordance with the teachings of the best author- 
ities on the subject, I think it is so radically wrong that 
if you would leave undone everything that the author has 
said to do, and do everything he has said not to do, you 
would come nearer my idea of the correct and scientific 
treatment of the disease,' which I proceeded to give in 
every detail. It was not however well received. The 
author of the aforesaid paper condemned my doctrines 
most severely and forcibly. To his credit be it said, that 
he afterward, in an address to the society, remarked 
that although he had expressed his disapproval of these 
special therapeutic methods in the very strongest 



34 CAN TYPHOID FEVER BE ABORTED. 

language at his command, that these discussions had set 
him thinking. He told them that he had searched his 
library over and over to find any authority upon which I 
could have based my claims — that there was nothing in 
all of the medical books bearing on my very peculiar 
theory — but, nevertheless I was right and he would not 
again dare to treat a case of typhoid fever in any other 
way than in the manner which I had described and so 
enthusiastically advocated. 

At this point I must express my regret that of my 
earlier cases of typhoid fever no bedside histories were 
recorded. No idea had entered my mind at that time of 
inflicting upon an already overworked and enduring pro- 
fession my remarkable theories. The clinical memoranda 
and charts of many of the later cases are in my posses- 
sion and are open to the inspection of any scientist of 
this society. They are well worth studying seriously. 

I wish now to call your attention to a few cases of 
enteric fever, which illustrate the most marked results of 
my work during the intervening years while I was still 
investigating and experimenting with the many different 
kinds of antiseptics which were brought to my notice. I 
have selected, as example of the many, only such cases 
as were diagnosticated by able, clever and expert physi- 
cians, cases which bore such well-marked symptoms as 
were quite characteristic of the disease, or were sur- 
rounded by such circumstances as would indicate beyond 
the possibility of a doubt that they were really typhoid 
fever. 

The limits of this paper will however only admit 
of the presentation of the most salient features of those 
cases which best illustrate a point, and in estimating 
their value it should be borne in mind that only a few of 



CAN TYPHOID FEVER BE ABORTED. 35 

the teachings of the editorial which I have quoted were 
followed in these instances. Many of these patients 
were allowed to get up or move about, or to go out of 
doors at pleasure. Nurses, trained or untrained, were 
allowed to sponge or not to sponge them. No other 
baths were given except to meet the ordinary demands 
of cleanliness. Very little effort was made to " control 
the symptoms." No " simple mixtures designed to main- 
tain free action of the kidneys or stomach, chiefly to 
comfort the patient and his friends, " were ordered. No 
medicine was ever exhibited for the purpose of directly 
reducing the temperature ; and while the patient and his 
attendants were generally warned against the danger, 
real or supposed, of eating solid food, the warning was 
not always heeded. Some of these patients ate solid 
food on the seventh day of treatment ; others on the 
twelfth day, and many were not restricted as to the diet 
any of the time, eating as they pleased. 

The following cases which I treated between the 
years 1882 and 1892 have been selected as especially in- 
teresting. Of these I have no clinical charts. 

On the 17th of July, 1882, I was called to see the 
son of Dr. F., after the attending physician had made 
a diagnosis of typhoid fever. I immediately put him on 
antiseptic treatment and he made a complete recovery 
in twenty days, his temperature having been normal 
several days when I discharged him. 

A young gentleman died of enteric fever. Clara 
P. lived in the same house and had assisted in nurs- 
ing him during his illness. Two or three days later I 
was called and made a diagnosis of typhoid fever, and 
in reply to direct questions said that she would probably 
be well in ten or twelve days. On my second visit I was 



36 CAN TYPHOID FEVER BE ABORTED. 

told that another physician had seen her before I had 
done so, made a diagnosis of typhoid fever, a prognosis 
that she would be ill four or five weeks at least. Her 
temperature went up to 104f° F. Tympanitis was well 
marked and rose spots were abundant. She made a 
good recovery, and was out to drive on the twelfth 
day. 

The wife of one of our leading druggists, Mr. W. W. 
McK., had typoid fever from which she made a good 
though not a rapid recovery. 

Mrs. Johnson W. and her son both had typhoid 
fever. Their recovery took place in eleven and fifteen 
days respectively. In both cases the symptoms were 
well marked. 

Last winter, when typhoid fever was so fatal at 
Beaver Falls, Mr. L., Jr., was brought home with the 
disease, from which he recovered in twelve days. His 
symptoms were all characteristic of the disease. 

Ulysses S. was brought home from a boarding 
house in Wampum, where at least one death had re- 
sulted from typhoid fever. Dr. Wickham, of this city, 
made a diagnosis of the disease, and treated him for 
three days, when I was called. I found a well-marked 
and typical case of typhoid fever, with a history of ten 
days' sickness. Temperature 105.8°; pulse 124 ; bowels 
very tympanitic, petechia abundant, tongue brown, hard 
and dry; stupor so profound that he could with difficulty 
be sufficiently aroused to show it. My first visit was 
made on October 25. The last on November 3, when 
he was sitting up. On November 10 he called at my 
office and settled his account. 

When typhoid fever was so prevalent and so fatal 
near the corner of Bryson and Spring Streets, I was 



CAN TYPHOID FEVER BE ABORTED. 37 

called to see the two daughters of Joseph D. diag- 
nosed as typhoid fever, by a nurse of long experience in 
nursing the disease. Found both cases well-marked. 
Both recovered in less than ten days. Mr. John H. 
W., who lived in the same locality and was ill at the 
same time, made a good recovery from the disease in 
ten days. His symptoms were all well marked and 
characteristic of the disease. 

Thomas E., of Girard, came to my office to con- 
sult me ; after examining him two or three times, I told 
him he had typhoid fever. He then informed me that 
his wife was also very sick ; when I gave him medicine 
for her as well as himself and told him to send her to 
me as soon as possible. The next day I found her 
lying on the sofa in my office, having come by train five 
miles. Her temperature 104.3°; bowels very tym- 
panitic and tender, all the symptoms pointing to a very 
severe attack of typhoid fever. She was told to come 
each alternate day to my office, as was also her hus- 
band. The latter was permitted to work at his usual 
occupation, that of a stationary engineer, throughout 
his illness. After a few days, Mr. E. told me that 
the doctors in Girard were laughing at him for going 

away from home to a fool of a doctor who would 

tell him he had typhoid fever and could work. I asked 
him if they doubted his ability to work. He said, " No, 
they know I can work, but they say I have not typhoid 
fever." I told him if that were true, when he and his 
wife had recovered that would be the end, while if they 
had typhoid fever there would be more cases around 
them. Within a few weeks thereafter I was called in 
consultation to nine or ten well-marked cases along the 
Little Valley in which they lived, and all within a stone's 



38 CAN TYPHOID FEVER BE ABORTED. 

throw of their home. After several had had haemorrhage 
of the bowels, and four or five had died, there was no 
further question as to the character of the disease. The 
President of our county medical society, Dr. Gibson, can 
tell whether some of these cases were typhoid fever or 
not. So also can the distinguished ex-President of the 
Ohio State Medical Society, Dr. McCurdy. Mrs. Evans 
was not able to come regularly to my office, but had to 
miss occasionally two days at a time. She was refused 
passage on the train by one of the railroad companies, 
on the ground that she had a contagious disease, and 
had to travel by a less convenient route. 

On May 8, 1893, I was called to North Jackson to 
see Mr. G. W. P., whose son had just died of typhoid 
fever, after repeated haemorrhages of the bowels, and 
found Mr. P., who had nursed his son thirty-five days, 
had himself been ill with typhoid fever seven days. I 
assured him that he was in no danger of dying, and that 
he would probably be well in ten or twelve days. He 
had a normal temperature on the tenth day. 

On the 27th of May, 1893, I was again called to 
North Jackson to see Wallace E., the son-in-law of Mr, 
P., whom I saw at once had a severe attack of enteric 
fever This opinion was not shared by his family phy- 
sician, who promised should the patient continue to be 
ill, and if I would leave the case in his hands, to tele- 
phone me within two days in regard to his condition 
and the result of treatment. I heard nothing more of 
him however until I saw the notice of his death some 
time after in the local paper. Thus in this little outbreak 
of four cases of typhoid fever I treated the worst of the 
two cases that I saw and from descriptions given me of 
the other two cases, probable the severest case at the 



CAN TYPHOID FEVER BE ABORTED. . 39 

outset of all of them, with result that my case recovered 
in ten days and all of the others died. 

Prior to the date at which this particular series of 
observations begins, I had had large experience in the 
treatment of typhoid fever both in hospital and private 
practice with most unsatisfactory results, and when I lis- 
tened to the various essays read in the section on the 
practice of medicine at the meeting of the A. M. A. in 
Washington, so antithetic in their recommendations for 
the treatment of the disease, I was reminded of these 
earlier experiences. My imagination pictured them in 
sharp contrast with the happier outcome of later years; 
and wishing that others might share with me the pleas- 
ure and comfort of curing a disease so much dreaded and 
that humanity might derive some benefit from any 
knowledge I might possess on the subject, I told the 
chairman of the section, Dr. Victor C. Vaughan, that if 
possible I would prepare a paper and read it in the sec- 
tion before its adjournment, and that in this address I 
would advise a more hopeful method of treatment for 
enteric fever. My work with the committee for the re- 
organization of the sections however took up so much 
of my time that the preparation of the paper was an 
impossibility. On the last day of the meeting Dr. 
Vaughan reminded the members of the section of my 
promise, and I then said that I hoped to be able to pre- 
pare and present a short report on the antiseptic treat- 
ment of enteric fever at the next meeting of the society. 

On my return to my home I availed myself of the 
opportunity of criticising a paper on the treatment of 
typhoid fever read by one of the members of my local 
society, and after condemning some of the remedies ad- 
vised as worse than useless, since they tended to aid the 



40 CAN TYPHOID FEVER BE ABORTED. 

disease to destroy the patient (a criticism justly appli- 
cable to many methods of treatment which have been 
advised by some very learned professors) I said, "I have 
long believed this disease to be due to a germ, whose 
earliest habitat in man is in the alimentary canal, thus 
the logical conclusion is, gastro-intestinal asepsis should 
be the prime object to be attained by the treatment, and 
when this can be obtained the problem of the abortive 
treatment of typhoid fever is easily and quickly solved. 
I believe that I have already acquired the knowledge 
necessary for its accomplishment. Will any member of 
the society aid me in making a demonstration of the fact? 
If my proposition is agreed to, I will not only provide 
all medicine but will make no extra charge for my own 
work and will allow all fees to go to the physician in at- 
tendance originally, making my visits in his company so 
that he may follow me in all of my course." 

I then consulted the president of the Ohio State 
Medical Society as to the propriety of publishing a paper 
on the antiseptic treatment of enteric fever and was ad- 
vised not to do so until I had sufficient evidence to prove 
to the medical profession to its entire satisfaction that 
the methods in vogue could be improved upon. As I 
was anxious to present a great array of aborted cases of 
typhoid fever which had been controlled by the antiseptic 
treatment, and as I had received a letter from the mayor 
of New York on the subject I went to that city and spent 
a week seeking an opportunity to demonstrate the cura- 
bility of the disease, under the observation of some of 
the famous professors of the metropolis. Failing to ac- 
complish what I wished I returned home quite discour- 
aged. I tried Philadelphia next, and for ten days devoted 
myself to a fruitless effort to have some one give my 



CAN TYPHOID FEVER BE ABORTED. 41 

method of antisepsis a trial in one of the great city hos- 
pitals, without publishing- a treatment that might prove 
valueless or misleading. Again I returned to my home, 
this time most truly disheartened. Although I believed 
myself able to cure one of the most fatal diseases of the 
Mississippi Valley, I did not dare to give to the world a 
treatment the action of which I could not explain and 
which on a more thorough trial might turn out to be a 
failure in the hands of more able but less enthusiastic 
practitioners. 

After this I corresponded with the heads of the 
health departments of all of the principal cities of the 
United States and Canada; and to the honor of all of the 
gentlemen who were connected with these departments 
not one of them hesitated or failed to furnish me with all 
of the information in their power; often at an outlay of 
great labor and no doubt great expense. A marked 
contrast to the treatment I had received elsewhere. I 
extend to them one and all my most earnest and 
hearty thanks. 

During the intervening years, I visited most of the 
large cities of the United States from the Potomac River 
to the Pacific coast. In Pittsburg, in Saint Louis, in 
Washington, I gave the resident physicians of the largest 
hospitals where typhoid fever was treated, the best 
knowledge on the subject that I possessed at the time. 
They politely promised to test my method of managing 
the disease and probably forgot all I had said before 
dinner. In Chicago, I succeeded in interesting the 
Commissioner of Health, Dr. John D. Ware, in my work. 
He asked me to give him a letter which he might show 
to the superintendents of the hospitals. As this letter 
and the answer to it, may become in the future, interest- 
ing reading, I present them here: 



42 CAN TYPHOID FEVER BE ABORTED. 

Youngstown, Ohio, May 5, 1892. 
John D. Ware, Esq., M. D., 

Commissioner of Health, City of Chicago. 

My Dear Doctor: You are aware, that in writing in fulfillment 
of my promise to you and in giving expression to my peculiar 
views of typhoid fever, I am winning for myself the uncoveted 
cognomen of "crank." You will remember I told you that I be- 
lieved the life of every uncomplicated case of this dread disease 
could be saved; that I believed the disease could be aborted and 
that I also believed the excreta, from properly treated cases of 
typhoid fever would prove to be innocuous. Long before I even 
hoped for such results, I believed that the disease was due to a 
germ; that the germ was in the earlier stages of the disease, con- 
fined to the alimentary tract; and that if the entire tract could be 
saturated with a germicide at once fatal to the germ, and harmless, 
or better still, beneficial to the patient, the happiest results would 
follow. 

That I have been for fifteen years, doing all this, without hav- 
ing published a word about it, should not be a discredit to me, 
since it has taken years of testing, to satisfy even myself, and no 
one likes to have to eat his own words, especially after they have 
gone into cold type. 

Now, Doctor, if you can, as soon as possible, secure a ward for 
male, and one for female patients, with a day and a night nurse for 
each ward, and give me as many cases as possible, none of which 
have had the disease more than eight days, I will go to Chicago 
and appear before a Committee of your selection, consisting of 
members of the regular profession, upon whose judgment, and 
integrity you could rely; explain to them fully my plan of treat- 
ment, and if they find any medicine that I wish to administer is, in 
the proper dose, dangerous, they shall refuse permission to make 
the test, but for no other reason; you to invite any members of the 
regular profession, as many as you wish, to watch the patients 
from day to day, and if my test is entirely satisfactory, I am to 
have the privilege of giving the treatment to the profession through 
the American Medical Association. 

Very respectfully, 

John Eliot Woodbridge. 



CAN TYPHOID FEVER BE ABORTED. 43 

In reply I received the following letter: 

Chicago, May 27, 1892. 
John E. Woodbridge, Esq., 

Youngstown, Ohio, No. 29 W. Federal St. 

My Dear Doctor : Your letter of May 5 arrived while I was 
away from the department, sick. I did not return till the 20th., 
and have endeavored, from that day till this, to interview the 
physicians at different hospitals relative to the subject matter of 
your letter. 

Replying, I will say, I have seen the superintendents with 
whom I thought possibly I might prevail upon to coincide with 
our views relative to treatment of typhoid fever. I have also 
talked with some of the prominent men in the profession, and I be- 
lieve without a single exception, each and every one of them have 
said this : " Why does not Dr. Woodbridge read his paper before 
the National Association next June ? " 

I have said all that I could say relative to the subject which 
is one that I have become deeply interested in, but being only one 
man, it has been impossible, apparently, to make any impression 
upon the members of the profession. 

By reading between the lines you will probably understand 
more than is written. I do sincerely hope that you will read this 
paper before the National Association as I believe that it would 
result in a revolution in the treatment of this disease. 

No one would dare question your paper so far as your results 
in the past have been concerned, no matter how skeptical they 
might be in other matters. 

Trusting that you will pardon the delay in replying, 
I am, sincerely yours, 

John D. Ware, Commissioner of Health. 

Finally, after having spent years of valuable time, 
much money, and traveled many thousands of miles, I 
heard of the epidemic of typhoid fever at Ironwood, 
Michigan, and although I had been too busy to go to 
the Milwaukee meeting of the American Medical Associ- 
ation a few days before, I again sacrificed both time and 



44 



CAN TYPHOID FEVER BE ABORTED. 



money, and in a day was on'my way to the scene of the 
worst epidemic of typhoid fever of which I have any 
knowledge. The disease presented largely the charac- 
teristics and symptoms, so common in our sporadic 
cases. In some instances, however, the poison seemed 
to be so virulent, as to lead one to despair, almost from 
the very outset. 

A good representative of this class, was Miss T. S. 
Case, No. 22, whose bedside chart I hand you. When 



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seen on June 25, 1893, her pulse, as you will see, was 
120; her temperature, 105; her bowels were intensely 
tympanitic ; marked dullness over the spleen ; tongue 
dry, hard, and brown ; slight wandering delirium, which 
soon became so profound that we were unable to take 
her temperature under the tongue again for several 
days. Altogether, her condition was so bad that the 
attending physician, Dr. McLeod, a gentleman of un- 



CAN TYPHOID FEVER BE ABORTED. 45 

usual ability, after the examination was completed,* 
turned to me and said: "You don't want to treat 
that girl ; she will surely die." I answered : " Not if 
I treat her." After our second visit, Dr. McLeod said as 
we went away: " If you can cure that girl, you are a 
' dandy.' " 

She began to improve on the night of the third day, 
at which time Dr. McLeod came to my hotel to tell me 
that she was exceedingly delirious ; pulse 140 ; tem- 
perature, as well as could be taken in the axilla, in her 
extremely restless condition, was 104.8 ; her bowels 
were exceedingly tympanitic ; and she was bleeding so 
profusely, that he had to plug both posterior, and ante- 
rior nares. The amelioriation of all these symptoms was 
rapid and the temperature touched normal on the tenth 
day of treatment. 

In the same room with T. S., Case No. 22, lay her 
sister, P. S., Case No. 28, who had been taken sick at 
the same time; an equally typical case though somewhat 
milder; her temperature, as you see, was never high, and 
was subnormal on July 4, the ninth day of treatment. 

The chart of Mr. F. S., Case No. 24, is very inter- 
esting, as showing the result of treatment, after continued 
reinfection. The case bade fair to be a very severe 
one, but the temperature of 103.2, on June 26, dropped 
to 99.4 on the 30th. It again rose, on discontinuing 
treatment to 104.8, on July 2, when investigation 
showed, that he had been drinking water from a well, 
from which a dozen very severe cases had originated. 

Case No. 25. Mrs. M. T., whose temperature was 
in the afternoon of June 25, 103 degrees, and on the fol- 



* This conversation occurred while making a tour of the Typhoid Fever 
Hospital, and seeing patients in private practice, with the leading physicians of 
Ironwood, who had very kindly consented to place under such treatment as I 
should advise, all cases of the disease which I was willing to make an effort to 
abort 



46 CAN TYPHOID FEVER BE ABORTED. 

lowing morning, June 26, 103.8; touched normal on 
July 9, the fourteenth day of treatment. 

Case No. 26. Charles O., had on June 26 a tem- 
perature of 101 degrees, on June 28, 101 j^. He was 
up, and dressed on the following day, when his 
temperature had dropped to 100.5, and it touched normal 
on the eighth day of treatment, but went up to 100 de- 
grees on the eleventh. He was discharged on the 14th 
day of treatment. 

Case No. 27. Mabel T., was one of five cases in 
the same house, every member of the family having the 
disease. Her temperature was on June 25 (the first 
time I saw her), 103 degrees, pulse 120. The following 
morning it was 103 y 2 , and soon afterward was 104 de- 
grees, had been reduced to 98.8 degrees, with a pulse of 
84 on the 5th of July. 

Case No. 28. Mrs. T., aged 51, had on June 25 
a temperature of 101.5, pulse 104 which was reduced to 
98 degrees on July 4, with a pulse of 76. 

Case No. 29. Charles E. E., aged 45; on June 30 
had a temperature at 10:30 in the morning of 100.4; in 
the evening was 102.8, and at 8 o'clock was 103.6; was 
reduced to 98.6, on July 8. 

Case No. 30. John A., aged 33 years, at 7:30 
P. M. had a temperature of 103, pulse 84. This was re- 
duced, on July 8, to 98.6 degrees. 

Case No. 31. Mrs. L., aged 31 years; had June 
25 a pulse of 96, and a temperature of 102. At noon 
the following day 102^, and was subnormal on July 6. 

Case No 32. Eddie T., aged 12 had a temper 
ature of 101.6 degrees on June 25, with a pulse of 80, 
was very hungry on the 27th and 28. His tempera- 
ture afterward went up to 102^, but was on July 8 
subnormal. 

Case No. 33. Mr. M., aged 20 years; on June 25 
had a morning temperature of 102 degrees, which on 
July 9 was 98^; pulse 63. 

Case No. 34. Albertina O., aged 16 years ; on June 



CAN TYPHOID FEVER BE ABORTED. 47 

28, with a pulse of 120, had a temperature of 103.8; 
which on July 9 was normal. 

Case No. 35. Ed. O., aged 25 years ; came under 
my care on the afternoon of June 25 ; had been sick 
eight or nine days, and proved to be a very obstinate 
case, the temperature being 104 degrees on the third day 
of treatment, and 103.6 on the sixth day of treatment, 
from which it dropped to normal on the fourteenth day, 
with a pulse of 72. 

Case No. 36. G. T. G., aged 28 years. This 
patient was admitted to the hospital at 3 o'clock P. M. 
of June 26. Pulse 80 ; temperature 97.4, but with the 
other symptoms so characteristic of the disease as to 
leave no doubt in my mind that he was entitled to admis- 
sion to the Typhoid Fever Hospital. The disease did 
not yield readily to treatment. On the fifth day his tem- 
perature was 104. Went below normal on the ninth 
day, but went up again to 101, whence it gradually 
dropped to 97 degrees on the fourteenth day of treat- 
ment. 

Chart No. 37. John A., aged 32 years. He had 
been sick three days when admitted on June 24. His 
treatment may be regarded as a failure. His tempera- 
ture was 100.6 when last seen on July 9. He had prob- 
ably been ill longer than we had supposed. 

We made two or three such mistakes. One of the 
cases selected on the supposition that he had been ill 
less than eight days, was found to be dying of perfora- 
tion of the bowels when we went to him to administer 
the first dose of medicine. Another case, after having 
been put under treatment, showed conclusive evidence 
of having been well along toward perforation, died a few 
days later. 

These records were kept by the physicians attending 
the patients, and by the trained nurses in the Typhoid 
Fever Hospital. The physicians were all gentlemen of 



48 CAN TYPHOID FEVER BE ABORTED. 

unusual talent and capability, and of very large experi- 
ence in the diagnosis and treatment of typhoid fever. 
Dr. McLeod, the able Superintendent of the Union 
Hospital, is a gentleman who would be an ornament to 
the profession in the world's most enlightened capitals. 
Dr. Neven, the Health Officer of the city of Ironwood, 
is a gentleman whose skill and ability were factors of 
prime importance in fighting this fearful epidemic. 
Under his magic touch, the conception of to-day became 
the finished work of to-morrow, and the armory, re- 
sounding now to officers' commands, became an hos- 
pital for typhoid fever, perfectly equipped under his able 
superintendence, and instead of echoing to the soldier's 
martial tread, the soft footfalls of a corps of trained 
nurses, scarcely broke the silence. It is enough to say 
of these nurses, that they were trained, in the city of 
Chicago. It was the freely expressed opinion of both 
physicians and nurses, that they had never seen typhoid 
fever patients do, or feel so well. 

I present here a letter, voluntarily handed me by Dr. 
Neven : 

Ironwood, Michigan, July 9, 1893. 

This is to certify, that all the patients, whose bedside histories 
are in the hands of Dr. Woodbridge, were diagnosed as cases of 
typhoid fever by Drs. McLeod, Holmes, Neven and Woodbridge, 
in the city of Ironwood, State of Michigan, and that they were all 
under Dr. Woodbridge's special treatment, no other medicine be- 
ing exhited during their sickness. 

I also can state, that in no case did any serious condition arise,, 
as did in other cases, treated side by side, by the same physicians 
with the older, most approved methods of modern treatment. 

J. K. Neven, M. D., 
Health Officer of the City. 
Physician in Charge of Typhoid Fever Hospital. 



CAN TYPHOID FEVER BE ABORTED. 49 

The original bedside charts of all the cases treated, 
either in the Typhoid Fever Hospital, or in private prac- 
tice, as verified by the physicians in charge, are in my 
possession and open to the inspection of any one inter- 
ested in the advancement of science. 

Dr. McLeod, of the Union Hospital, Dr. Neven, of 
the Typhoid Fever Hospital and their corps of assistants 
and nurses are entitled to the highest gratitude and 
thanks of humanity for so ably furthering and assisting 
me in these important investigations. 

Immediately upon my return from Ironwood, I read 
a paper in my local society, giving a lengthened account 
of my investigations and of my work on the subject of 
typhoid fever up to that date, July 17, 1893, exhibiting 
the original charts and letters from Ironwood, as evi- 
dence in part of the truth of my oft reiterated declara- 
tion that typhoid fever can be aborted, and that death is 
a wholly unnecessary consequence of the disease. I 
reminded the society, that thirteen years previously I 
had outlined before that body, the treatment which had 
given me such brilliant results. 

I wish now to present the clinical charts and brief 
reports of a few of the most interesting and character- 
istic cases which I have treated since my return to my 
home from my sojourn in the north of Michigan. 

On the day my paper was read in my local society, I 
was called to see Ed. M., (Case No. 38, the chart of 
which is now offered for inspection) .* I found him with 
a temperature of 104^°. The next day it was 104.4° 
and the day following, 104.8°, from which time it gradu- 



*The cut of this and many other charts which appeared in my earlier papers 
have been mislaid, but as they had been freely exhibited it was not thought neces- 
sary to reproduce them. 



50 



CAN TYPHOID FEVER BE ABORTED. 



ally declined to normal on the morning of the eighth day 
of treatment, although he had a rise of temperature for 
several days thereafter; he walked out on the eighth day; 
ate a slice of bread on the tenth day for supper. For 
breakfast on the eleventh day, he ate two slices of bread, 
two eggs, and two cakes, and continued eating heartily 
from that time.* 



104^ 



103° 



JiayofDi 
JPuTs 



Hesp 




On July 24, Leo M., Case No. 39 son of Case No. 38, 
was taken sick, and on examination, gave the following 
register: Temperature 102^ in the morning, which 
rose to 104i on the fourth day, and 105 on the fifth 
day of treatment; pulse 112 the first day, 160 the fifth 
day; the bowels became intensely tympanitic, rose spots 
appeared in profusion, and all the symptoms pointed to 



*The mention of this indiscretion must not be understood to mean that it 
was sanctioned by me. 



CAN TYPHOID FEVER BE ABORTED. 51 

an exceedingly severe attack of typhoid fever. Turning 
to Mr. M., with the thermometer in my hand, indicating a 
temperature of 105°, I said, "Fifteen years ago, had you 
been lying there with typhoid fever, your wife also 
showing well-marked symptoms of the disease, and these 
symptoms present in this boy, I should have said sadly: 
1 He is very ill with typhoid fever; he will probably be 
sick four or five weeks, or longer;' and if asked for a 
prognosis, would have said: ' He is in great danger;' 
now I cheerfully say: * He has typhoid fever; he will 
probably be sick ten days, or two weeks, or may be 
mildly sick somewhat longer. There is no danger.' " 
The temperature touched normal on the sixteenth day of 
treatment. 

These cases were examined at various times, by Dr. 
H. H. Hahn, Dr. Thomas, and Dr. Robert Gibson, 
President of the Mahoning County Medical Society, and 
all were positively diagnosed as typhoid fever. You will 
find the statements of these physicians on the original 
charts. 

Case No. 40. Mrs. M. Her symptoms were decided- 
ly characteristic, although her temperature was not high at 
any time nor was she confined to her bed all of any day. 
The temperature touched normal on the eighth day of 
treatment. 

On August 11, 1893, I was called to see Lizzie, 
Case No. 42, who had been sick a few days prior to 
August 1, when she first consulted a physician, who re 
ported a temperature of 103° on that day. He treated 
her four or five days, when another physician was called 
who did not fully make up his mind whether she had 
typhoid fever or not. I was then called, and found a 
temperature of 104^°. I hesitated whether to attempt 
antiseptic treatment at so late a day ; for six days, the 
afternoon temperatures were, 104.5, 103.5, 10o^, 102.6, 



52 CAN TYPHOID FEVER BE ABORTED. 

101 %°, 101.2°. The pulse ranged from 90 to 96. The 
improvement in the patient's general condition, however, 
was greater than the fall in temperature would indicate. 
She became cheerful, complained of hunger, and wanted 
to get up ; the bowels, which had been tender, and very 
tympanitic, lost for a time, all tenderness, and tympan- 
ites. Both, however, returned in a slight degree, after 
a few days, and the temperature remained above normal 
for two or three weeks, all antiseptic treatment having 
been abandoned after the twelfth day. This case is in- 
teresting, as showing the effect of what I believe to be 
germicidal treatment, even when too late to abort the 
disease. 

While visiting Case No. 42, I was called to the next 
house to see the daughter of IJx-Marshal Crowley, Case 
No. 46, whose symptoms of typhoid fever were well- 
marked. Her temperature was 103°, pulse 112. She re- 
covered in less than a week. 

On September 17, 1893, I was called to see John H., 
Case No. 41, positively diagnosed as typhoid fever by 
four physicians. His symptoms were well marked, and 
rose spots very abundant. His pulse and temperature ran 
a very common course ; I give them daily under the 
dates : 

September 17. Temperature, 103:6°; pulse, 92. 

September 18. Temperature, 104.6°; pulse, 92. 

September 19. Temperature, 104.8°; pulse, 98. 

September 20. Temperature, 103°; pulse, 80. 

September 21. Temperature, 102^°, 

September 22. Temperature, 102.2°; pulse, 78. 

September 23. Temperature, 101^°; pulse, 76. 

September 24. Temperature, 100.6°; pulse, 72. 

September 25. Temperature, 100.6°; pulse, 70. 

September 26. Temperature, 97.6°; pulse, 64. 

September 27. Temperature, 98^°; pulse, 68. 

September 28. Temperature, 98.2°; pulse, 64. 

On September 29, I was called to see Case No. 47, 
Ralph H., brother of Case No. 41. He was living in 



CAN TYPHOID FEVER BE ABORTED. 53 

the same house with his brother when taken ill and is 
now lying sick with typhoid fever. I will give his chart 
in a future paper, as well as six or eight other charts of 
cases now under treatment. 

On the 23d of September, 1893, I was called to 
Washingtonville, to see William W., Case No. 48, sick 
with typhoid fever, diagnosed by his attending physi- 
cian, Dr. Powers, confirmed by Dr. Bertelott in consul- 
tation. His temperature was normal on September 29, 
and so continued till he was quite well. 

I have made in this paper a brief summary of some 
of the worst cases and worst results I have had in my 
private practice for more than twelve years, during which 
time I have had no death from typhoid fever. During 
the same period, I have had a large number of cases, in 
which a diagnosis of typhoid fever was made, but which 
recovered in from three to twelve days, without present- 
ing pathognomonic symptoms of the disease. The re- 
markable success I have had in these cases leads me to 
hope and believe that the alimentary canal should be 
thoroughly asepticized, at the earliest possible moment 
in all suspicious cases, and that by so doing, only good 
fortune will ensue. 

Keenly alive to the ignominy and disgrace that 
await me, should future observations contradict the re- 
sults and conclusions of the past ; aware, too, of the 
danger of the too implicit reliance on a limited number 
of observations, and with all due respect, for the teach- 
ings of the great thinkers of the profession, whose 
wisdom has, with strange unanimity, taught the con- 
trary, I yet wish to answer my question : " Can Typhoid 
Fever be Aborted ? " in the affirmative. 



CAN TYPHOID FEVER BE ABORTED.* 



In my last paper, published in the current issue of the 
Journal of the American Medical Associatio7i y I concluded 
the history of my cases with a partial report of Case No. 
41, John H., who had not at that time recovered from his ill- 
ness, and with the promise that I would report the case of 
his brother, Ralph H., Case No. 47, together with six or 
eiorht other cases which were under treatment at the time 

o 

the article was written. Some of these patients recovered, 
without having developed pathognomonic symptoms of ty- 
phoid fever, and consequently cannot be reckoned as such. 
Case No. 41. J. H. This case is especially interest- 
ing. I was not aware until several weeks after his recovery, 
that his attending physician, a personal friend of mine, after 
having made a diagnosis of typhoid had been discharged, 
and myself called, although I did think the family unusually 
inquisitive, when I gave a diagnosis of typhoid fever, and a 
prognosis of ten or twelve days' sickness, no danger. On 
the seventh day of treatment, when the rose spots were 
abundant, and other symptoms well marked, I asked Dr. 
Thomas, one of the best diagnosticians in our society, to 
examine. him, and make a diagnosis ; he did so and said at 
once, ''that is typhoid fever, and I will sustain you in that 
diagnosis at any and all times," and added, " my experience 
with cases of this character is, that recovery is slow and 
tedious." I said, " I shall ask you to come here in two or 
three days to see a case of aborted typhoid fever." I also 
inquired. " Doctor, would you dare to give this man solid 



*Read before the Mahoning County, Ohio, Medical Society February 12, 1894. 

54 



CAN TYPHOID FEVER BE ABORTED. 55 

food?" "If he were my patient I should certainly not," 
he said. Turning- to the man, I told him of the opinions 
held by the best thinkers of the profession, in regard to eat- 
ing- solid food, warned him of the supposed danger and then 
asked him if he would be willing to eat a piece of beefsteak. 
He said yes, if I advised him to do so. However, even 
after I told him it must be on his own responsibility, he ate 
the steak without ill effects, and on the ninth day, I asked 
Dr. Thomas to re-examine him, when his temperature was 
found to be 97°. He was discharged cured, on Septem- 
ber 28. 

Case No. 47. Ralph H., brother of Case No. 41, re- 
siding with him. He was taken sick on September 29 ; pulse, 
100; temperature, 103°. The appearance of the tongue, the 
severe headache, and all other symptoms were characteristic ; 
later rose spots were abundant, and dullness over the spleen 
was well marked. After treating him five days, I wished 
to be away at the meeting of the Mississippi Valley Medical 
Association and the World's Fair, so I asked Dr. McCurdy, 
a member of our society, to take charge of him, together 
with Cases Nos. 43 and 44, which he did, continuing my 
treatment, so that in all of these cases I had the advantage 
of his valued confirmation of my diagnosis. The tempera- 
ture of the patient touched normal on the twelfth day of 
treatment. 

Case No. 45. William W. This patient was seen in 
consultation with the attending physician, but lived at so 
great a distance that I was only able to see him twice. On 
my first visit I found the temperature 104.8° and within 
the next twenty-four hours it went above 105°, this being 
the eleventh day of illness. When I saw him again four 
days later, the temperature had dropped to 103.2° notwith- 
standing which his friends entertained little hope of his re- 
covery, so serious seemed his condition. However, he 
steadily improved, and five days later his temperature was 
normal and his recovery rapid and complete. 

Case No. 49. William T. On October 31, 1893, 
Dr. J. J. Thomas, who had seen the result of my treat- 



56 



CAN TYPHOID FEVER BE ABORTED. 



ment in two or three cases, telephoned me that he had a 
typical case of typhoid fever to which he would like to 
have my treatment applied. After examining- the invalid 
I expressed the opinion that he had been ill more 
than ten days ; that there was but a limited area of intes- 
tine involved, but that it was bordering closely on ulcera- 
tion. Although the temperature was not high, he did 
not recover entirely for eighteen days. 

Case No 50. B. C. W. W. This case presented 
well-marked and characteristic symptoms. Recovery 
followed by alopecia. 




Case 51. Angus McP., aged 27 years. In the eve- 
ning of January 22, I was called to see this patient. After 
examining him, I said: "This man has had typhoid 
fever more than two weeks." They answered : " Yes, he 
had a chill two weeks ago last night." The next morning 
I took Dr. McCurdy with me to see him. We failed to 
get the morning temperature, which the night before had 
been 105£°. He was voiding both urine and feces, in- 
voluntarily ; his teeth, gums, and lips, were covered with 
sordes, which his faithful nurse, his wife, was unable to 
keep cleared away. His bowels were intensely tympan- 
itic ; in short, all his symptoms were characteristic. I 
hand you his chart, to show the result of treatment dur- 
ing the first few days, which has since been far from sat- 
isfactory, and the end is not yet. 



CAN TYPHOID FEVER BE ABORTED. 57 

Case 52. Willis H., aged 9 years. On returning 
from my first visit to Case No. 51, on January 22, I 
found a gentleman waiting to have me go to see a child, 
who was supposed to have typhoid fever. He had been 
with his mother, who was nursing her brother, through a 
five weeks' attack of the disease. His symptoms were all 
well marked, the temperature being 104 4°, when I made 
my third visit on the evening of January 23. Dr. Barnes 
examined him and confirmed my diagnosis. The tem- 
perature was below normal on the tenth day. 

Case No. 53. Guy H., aged 6 years, brother of 
Case No. 52, was taken sick on January 28 with char- 
acteristic symptoms of the disease ; pulse 112 ; temper- 
ature 104°. He recovered, however, before a positive 
diagnosis could be made. 

Case No. 55. Thomas M. On February 6 I was 
called to see this patient, who lived within a few rods 
of Case No. 51, his helper in the mill, and his friend and 
nurse during his present sickness. His symptoms were 
characteristic and indicated the beginning of a very severe 
attack of typhoid fever. His chart shows the result of 
treatment to the present time. After visiting him two or 
three times I told him he had typhoid fever, but as treat- 
ment was commenced so early he would be able to sit up 
and eat solid food in a few days ; and that there was no 
danger of his being as sick as his friend (whom I did not 
see until the sixteenth day of illness), or of dying. Dr. 
Robert D. Gibson, the last President of the Mahoning 
County Medical Society, visited this case with me and 
confirmed the diagnosis. 

Case No. 43. Frank V was a rather severe case of 
typhoid fever. I saw him first on September 27. On 
September 30, the fourth day of treatment, the temper- 
ature was 104i°. Three days later, I left him with a 
temperature of 101.7° in charge of Dr. McCurdy, who 
confirmed the diagnosis, and continued the treatment, and 
discharged him cured on the fourteenth clay of treatment. 
I had attended his brother through an attack of the same 



58 CAN TYPHOID FEVER BE ABORTED. 

disease, some time before, from which he made a most 
satisfactory recovery; however, I did not keep a special 
record of his case. 

Case No. 44. Mrs. F., was the third case of typhoid 
fever left in Dr. McCurdy's care at this time. He confirmed 
the diagnosis, and continued the treatment and discharged 
the patient on the eighth day. 

Cases Nos. 40, 46 and 53, are excluded from the esti- 
mates of my cases, because they recovered before a posi- 
tive diagnosis was possible, as is also Case No. 42, 
because there was unquestionably ulceration of Peyer's 
glands, before I was called. 

With the exception of one patient who was dying when 
I was called, in consultation with the attending physician, 
and one other case, who had been sick thirty-five days 
when I saw him, and who afterward recovered, and a few 
doubtful cases, who were well before a positive diagnosis 
was possible, these are all the cases of typhoid fever I 
have seen since my last paper was written. They round 
out more than twelve years of active work without a death 
in my private practice from this disease; while my brother 
practitioners are having no better average results than I 
had in former years when my death rate was so high. 
Accept them for what they are worth, as additional evi- 
dence that my prediction that typhoid fever can be aborted, 
and that the life of every uncomplicated case of typhoid 
fever can be saved is a valid one. That this claim will be 
hotly contested, no one familiar with the most recent 
literature on the subject can doubt. 

What a contrast when compared with my personal ex- 
perience during the first sixteen years of my practice, which 
amply justifies the editorial quoted in my first paper, when 
my death rate was enormous, and the average duration of 
illness of those who recovered, as accurately as I can 



CAN TYPHOID FEVER BE AB0R1ED. 59 

estimate it was more than thirty-four days. As these esti- 
mates are made from memory, aided by very insufficient 
data, the accidental omission of some of the milder cases, 
may make both death rate and duration of disease too high. 
But, giving myself the benefit of the doubt, and excluding 
the large percentage of those who died, the estimates show 
that those who recovered, did so after more than a month 
of sickness, that must have left their constitutions fearfully 
shattered. They recovered, too, probably more in defiance 
than as a result of treatment — a sad commentary on sixteen 
years of careful, and conscientious work, according to the 
best light obtainable from any text-book within my reach at 
that or at the present time, as far as internal medication is 
concerned. 

Do not understand me to state that the result of treat- 
ment during all these sixteen years was equally bad. In 
1876 a new light began to dawn on me, and during the 
following seven years, to the beginning of 1882, when I had 
my last death from typhoid fever, my results were manifest- 
ly better, not alone in a greatly reduced death rate, but also 
in a great shortening of the average duration of sickness. 
In 1880, believing myself to be in possession of valuable 
knowledge on the treatment of typhoid fever, which ought 
to be given to my brother practitioners, I took advantage of 
the chance which was offered when a paper was read on 
the subject in this society, by one of its ablest members, to 
advance my own theories and doctrines on this subject of so 
much magnitude, and was much chagrined to find my 
critique almost ridiculed, and shall I say, contemptuously 
listened to by some, and myself standing entirely alone in 
the advocacy of a method of treatment which, though crude 
indeed, had yielded to me most excellent results, as com- 
pared with my early experiences. 



60 CAiV TYPHOID FEVER BE ABORTED. 

Years passed, and in 1891 another paper on the same 
subject was read in the same society, advising a course of 
treatment, only a little worse than the one I had so merci- 
lessly criticised eleven years before. In commenting upon 
this last paper, after showing why its recommendations 
were not only unwise, but absolutely dangerous, and 
driving its author to the refuge of the high authorities he 
'had copied, and to the further statement that he had ad- 
vised the remedies I had condemned as dangerous, in 
small doses only, I said that I had long believed typhoid 
fever to be due to a germ, whose earliest habitat in man 
was the alimentary canal, and that when a germicide 
powerful enough to destroy the germ, without detriment 
to the patient, could be brought in contact with it, that 
the problem of the abortive treatment of typhoid fever 
would have been solved, and that I believed the means of 
doing this were already at our disposal. 

The questions now are, what are these very important 
ingredients and how are they to be brought in contact 
with the germs which they are intended to destroy, and 
what other object, if any, are we to seek to accomplish 
that we may most speedily restore our patients to their 
normal condition of health. 

I must confess myself at a loss how to approach this 
part of my subject. Admitting that the germ enters the sys- 
tem most frequently with the water and food taken into the 
stomach, finds lodgment there, and multiplying, finds its 
way into the small intestines and further. I conceive that 
he will treat typhoid fever best, who best measures the con- 
dition of his patient, or rather the extent of territory over 
which thegerms have spread, and the amount of mischief 
already done, and having done this, so selects and applies 
his remedies as to most speedily stop their ravages, and 



CAN TYPHOID FEVER BE ABORTED. 61 

most effectually relieve the patient of the ptomaines, tox 
albumens, injuries to Peyer's glands, or other ill effects of 
theirtemporary sojourn. This is, I fear, a much too difficult 
task for me to undertake to-night. Some time in the 
future I hope to give expression to my views on these 
points, but at present I think I can do no better than to 
give the treatment of two or three typical cases of ty- 
phoid fever in connection with their bedside histories.* 

My cases have been too few to establish the value of 
my theory of treatment, but they have been too many 
and the results have been too good to admit of longer 
silence on my part, hence I deem it my duty to at once 
present such evidence as I have to the end that humanity 
may have the earliest possible benefit of my discovery. 

Thus far in my private practice I have had no death 
from typhoid fever in twelve years. I have been able to 
abort two or three cases which were first seen on the 
tenth day, and all of those cases which came under my care 
on or before the eighth day of sickness. It may not be 
possible to abort every case when the patient is first seen 
as late as the eighth day, nor is it necessary, for when the 
members of the medical profession and the people under- 
stand that typhoid fever can invariably be cured when the 
proper treatment is instituted at a sufficiently early stage 
of the disease, the physician will no longer wait until his 
patient is covered with rose spots or has one or more 
haemorrhages of the bowels before making an exact di- 
agnosis or beginning proper treatment. 

In conclusion, I beg that you will understand, that in 
criticisingthese papers which were written by physicians of 

*The treatment and prescriptions used in these cases have been omitted in 
this revised paper to avoid repetition, and because since the paper was first pub- 
lished they have been somewhat modified. 



62 CAN TYPHOID FEVER BE ABORTED. 

Youngstown, I wish to cast no slur on my colleagues in this 
society. Their work was neither better nor worse than 
that of the most learned members of the profession. I am 
sure that my associates of this society are the peers of an 
equal number of the members of the medical community in 
any spot on the globe, and when I invite their criticism of 
my reports of cases, of my unusual and singular ideas, and 
of my declaration that there are ze^Z/known drugs which do 
not only shorten the course of this disease, but the action 
of which in typhoid fever is in the highest degree abortive, 
I feel that I am standing before a tribunal, which would find 
errors if there were errors to be found. 



CAN TYPHOID FEVER BE ABORTED.* 



As a preface to my paper, I wish to acknowledge my 
indebtedness to the president of this society, to our last ex- 
president, to the president of the Ohio State Medical Soci- 
ety, now present, to Dr. Thomas, Dr. Barnes, Dr. Dickson, 
and to all other physicians who have confirmed my diago- 
ses and watched the result of my treatment of typhoid fever, 
or in any other way have aided me in my efforts to demon- 
strate the curability and non-fatalness of the disease. I wish 
also to thank them for their many kind and complimentary re- 
marks made during the discussion of some of my previous 
papers. Having my work characterized as the " greatest 
discovery of the age " by one member; my name associated 
with that of Jenner, by another ; and to have a third give 
expression to his pride, that a member of this society has 
done so great a work for humanity, would be exceedingly 
gratifying to me at any time, but especially so just now, 
when I am promulgating ideas, which must arouse the in- 
dignation of every great professor of the principles and 
practice of medicine in the world, because they, if true, will 
convict him of having taught errors, that have not only cost 
hundreds of lives, but have discouraged all investigation in 
this most important field. At this time too I must incur the 
bitter hostility of a large class of physicians, who not daring 

*Read before the Mahoning County, Ohio, Medical Society, March 12, 1894, 
with the records of the recovery of the cases reported in second paper, also the 
reports of cases of typhoid fever in the McPhee family, who were attacked by the 
disease after this paper was read in the society (Revised 1895.) 

63 



64 CAN TYPHOID FEVER BE ABORTED. 

to adopt my treatment, will condemn me for awakening 
hopes which can never be realized by the " expectant 
method " of treating typhoid fever ; or should they fail to 
secure with the antiseptic treatment, the results which I 
maintain are possible, they will forthwith lay all the blame 
to my method, rather than upon their application of it. 

May I also express my gratitute to the editor of the 
yoitrnai of the American Medical Association, for so aptly 
andsopromptly defendingme from the malicious and spite- 
ful attacks of the editors of two or three medical journals. 
I also desire to say to the members of this society that I 
fully appreciate their courtesy, in giving upmost of the time 
at the last meeting to my second paper on typhoid fever. 
And when they, by unanimous vote, gave me the floor 
again. this evening, I could not help wishing that my work 
were far enough advanced to enable me to make my third 
paper on typhoid fever somethingmore than a mere effort 
to inaugurate a new era in the diagnosis, prognosis and 
treatment of microbic diseases, the subject which for more 
than twenty years has lain nearest my heart and to which 
all of the best years of my life have been devoted. 

I do not wish at present to enter into a strictly scientific 
discussion of typhoid fever. Most of the investigations 
into the etiology and pathology of the malady, have been 
done by better observers than I can ever become ; and 
my own work in that direction is in too chaotic a state 
to be quoted by scientific men. 

We know too little of the bacteriological world, too lit- 
tle of the antagonisms existing between the minute deni- 
zens and as a consequence know so little of the etiology 
of typhoid fever, that we cannot affirm positively that any 
one germ invariably produces it ; and so little of the real 
action of the remedies which have been advised to be ad- 



CAN TYPHOID FEVER BE ABORTED. 65 

ministered, that we are unable to say whether 'the eucalyp- 
tol and guaiacol, or the creosote or calomel, or any one 
agent is essential, or how, or why a cure has constantly 
followed their exhibition. 

The importance of the subject to you, to all American 
and Canadian physicians, and indeed to all practitioners of 
medicine all over the world, wherever typhoid fever pre- 
vails, cannot be overestimated, because of its terrible mor- 
tality (the death rate in Pittsburgh in 1892 was 23 per 
cent) ; because of the broken constitutions of the more 
than 500,000 who recover from the disease in the United 
States annually, because the king upon his throne, the 
statesman wielding the destinies of the greatest nation, the 
merchant with his princely wealth, and the most brilliant 
physician, with all their resources, and all their power, can- 
not escape it, and because, last but not least, aside from the 
principles of treatment I have given you, there is known to 
men no means of aborting the disease, or of saving the life 
of every case. 

That I can do this, the reports of my cases of typhoid 
fever with the accompanying charts, shown you at the last 
meeting of this society, a few of which have been published 
in the Journal of the American Medical Association, should 
be conclusive evidence. They represent only the cases that 
I have treated since the 25th day of July, 1893, and of 
these only such as presented absolutely pathognomonic 
symptoms of typhoid fever, in nearly every one of which 
the diagnosis was confirmed by from one to five of the 
ablest diagnosticians in the country. 

At least, you must accept my declaration that all cases 
of typhoid fever, uncomplicated by pre-existing or coexist- 
ing disease, can be so modified as to cause them to run 
an exceedingly mild course, until you can produce proof 



66 CAN TYPHOID FEVER BE ABORTED. 

that I have failed in a single instance, by the application of 
antiseptic remedies to do it. A bold assertion, after read- 
ing Osier's statement : " The profession was long in learn- 
ing, that typhoid fever is not a disease to be treated by 
medicines," and "We are still without an agent, which can 
counteract the gradual influence of the poisons which de- 
velop in the course of acute febrile diseases, such as typhoid 
fever, pneumonia and diphtheria.' ' 

And yet, in 1880, in an unusually largely attended meet- 
ing of this society, twelve years before this book was pub- 
lished, I condemned all of the recognized methods of treat- 
ment of typhoid fever. I gave in detail my treatment and 
foreshadowed in some measure the important results 
which I expected to follow its adoption. I told the essayist 
of the evening, that if he would abandon his own, and all 
known beaten tracts of treatment, he would have better re- 
sults, and he, while expressing his respect for me as a care- 
ful practitioner, condemned my theories, and the remedies I 
proposed, as did every other member who joined in the 
discussion. 

In 1882, the subject of typhoid fever being under dis- 
cussion in this society, I said that intestinal haemorrhage 
would be unknown if the disease were properly treated, 
and that it would be a safe rule to send to State's prison 
any physician who ever had such an accident, presuppos- 
ing of course that he had been called to see the patient in 
due season. I admitted that such a law might occasionally 
do injustice, but claimed that its general effect would be 
beneficent. 

Some of you will remember, that on the 13th of No- 
vember, 1884, in the discussion of the term, "typho-mala- 
rial fever," I condemned its application to cases of true ty- 
phoid fever, with no malarial taint, and took occasion to say 



CAN TYPHOID FEVER BE ABORTED. 67 

at the same time, that the term, " malarial fever," was mis- 
applied, when used to designate a fever that runs three or 
four weeks without intermission, or distinct remissions and 
ends in death from intestinal haemorrhage, or exhaustion. 

You will remember, too, that again in 1890, I spoke 
in condemnation of the use of the coal tar derivatives, in 
the treatment of the disease. I said that doubtless a very 
large percentage of the deaths from heart failure were 
due to their exhibition. And again in 1890 I spoke to 
societies on the same subject, saying that I knew that 
typhoid fever could be aborted. Thus the fact that I 
have regarded typhoid fever as a curable disease has been 
no secret since 1880 ; it has also been well known that if 
I saw a patient before the sixth or eighth day of sickness 
I invariably gave the one prognosis, ten or twelve days' 
sickness, or if sick longer in so mild a way as to cause 
no uneasiness, no danger, and the medical profession 
abroad will understand that if I had failed in a single 
instance to make my prognosis good, both the people and 
the medical profession here would have held me re- 
sponsible years ago for every death. 

During all these years I had made every possible effort 
to prove the accuracy and certainty of my reasoning so 
that when I appeared before my society, claiming the ability 
to do what all of our preceptors teach and believe is impos- 
sible, I might have the means, not alone of proving my as- 
sertions, but also of defining the principles governing the 
proper treatment of the disease. But my dialectics were 
too absurd for belief, even by the most credulous. Although 
the authorities in some hospitals would permit me to see 
their patients, or make dissections, it was long an utter im- 
possibility for me to secure an opportunity to treat even a 
few patients in a public institution under the observation of 



68 CAN TYPHOID FEVER BE ABORTED. 

a skilled diagnostician, notwithstanding the fact that my ap- 
plications were supported by the highest credentials. 

I have met with so many discouragements, that lack of 
money alone prevented me from opening a hospital for 
typhoid fever, in which to demonstrate to the world how to 
abort the disease. A few thousand dollars, placed at my 
disposal in 1880, would long ago have resulted in the saving 
of many thousands of lives, as well as the great ameliora- 
tion of the condition of those other thousands who languish 
for weeks in a burning fever, and suffer the horrible pangs 
of hunger (I have felt them), and finally, as mere shadows 
of their former selves, emerge from their sick room, and 
creep about more dead than alive, often for months, when 
they might just as well have been sitting up and eating 
beefsteak, or bread and butter, after the sixth or seventh 
day of treatment. 

A few years since, when Dr. McCurdy was president of 
the Ohio State Medical Society, and by virtue of his office 
was the highest representative of the profession of the State, 
we had several interviews on the subject of publishing in 
some medical journal my claim that "Typhoid Fever can 
be aborted," and the method of treatment that seemed best 
calculated to produce this result ; and we both felt that with- 
out more conclusive evidence than I could then adduce of 
my ability to abort the disease, no possible good could be 
effected by such a publication. 

Although Dr. McCurdy has done me the honor to ac- 
credit me with having made "a wonderful discovery," yet 
he expressed the belief that premature public announcement 
would greatly imperil my professional career, and I under- 
stand that he still thinks (and I am sure the opinion is 
correct) that even now it would have been better to have 
waited a few years longer before giving publicity to and cir- 
culating abroad my extraordinary and original notions. 



CAN TYPHOID FEVER BE ABORTED. 69 

My cases are yet too few to carry conviction to the mind 
of every member of the profession that it is possible to abort 
typhoid fever ; and twelve years of active practice, without 
a death, is not long enough to convince every one of them 
that death is a wholly unnecessary consequence of the dis- 
ease. Could I conscientiously have waited until I could 
have reported the cases of twenty years without a death 
from typhoid fever, as well as a proportionately increased 
number of aborted cases ; could I have delayed until I had 
completed my investigations so far as to enable me to state 
with exactness, the laws upon which the scientific treatment 
of the disease depend ; I might then have been able to con- 
vince a sufficient number of thinking men that my theories 
are correct, and to have induced them to aid me in con- 
vincing the unthinking, and the treatment of typhoid fever 
would have been revolutionized. 

Now what will the result be ? We must wait and see. 
How long? Who can tell? The lessons of the past must 
be unlearned before the lessons of the future can be under- 
stood. All of the great sophists of archaism and the pedants 
of to-day have so iterated and reiterated the statement that 
typhoid fever cannot be aborted, that it will take long to 
efface from the memory that one sententious precept, espe- 
cially while the very best and latest manuals of medical edu- 
cation, as well as all of the lecturers in the universities of the 
world, are teaching quite the contrary ; and until this mis- 
teaching has been withdrawn from that curriculum, what 
may we expect ? 

With this bitter and blighting thought on the mind, can 
a physician hope for triumph ? Can he have a longing to 
be "master of the situation?" Can he be solicitous and 
eager to succeed with the abortive treatment of typhoid 
fever. Does he remember that only to the most careful 



70 CAN TYPHOID FEVER BE ABORTED. 

watching- and the most skillful use of the remedies at our 
command, will this treatment yield its happiest results. 
How can he gain his end in such a work y when he firmly 
believes in the impossibility of success, or how can he 
be expected to give due energy to a task so herculean to 
accomplish, in which he had no faith ? 

Another bit of instruction which it will be difficult to 
lose sight of, and which is taught by all our mentors and 
guides with great unanimity, is, not to treat symptoms. 
Early in the disease, a patient with a temperature of 105° 
or 106° should be treated exactly as one with a temperature 
of 101° or 102°. The physician who says that the impor- 
tant object to be attained is to bring the temperature down, 
is like the man who would attempt to resuscitate a drown- 
ing man without first having taken him out of the water, 
and the end would probably be the same in either instance. 
It is not the symptom that kills the patient, and one patient 
with a temperature of 105° may be on the high road to re- 
covery, while another with a temperature of 101°, or even 
lower, may be rapidly approaching the grave. Watch the 
temperature, the pulse, and all other symptoms as matters 
of scientific interest, and as showing the result of treatment 
given hours, or even days before, but not as giving any 
indication for treatment in the future. This rule applies 
only in cases which have been properly treated prior to the 
eighth day of disease. 

In a paper read before this society last month, I gave in 
detail the treatment of three typical cases of typhoid fever. 
Two of these were treated regardless of symptoms, and the 
other (whom I did not see until the sixteenth day of his 
disease, and for that reason) was treated almost entirely 
by the symptoms. All of these cases recovered, but while 
one was not allowed any solid food for ten days after his 



CAN TYPHOID FEVER BE ABORTED. 71 

temperature was normal, the others ate solid food all the 
time. Two were never sponged at all, while the other was 
sponged thoroughly. The one was not allowed to rise 
even to stool, the others sat up and walked about, and one 
of them went out of doors during his illness. The detailed 
treatment of these individual cases was given, because I ex- 
hibited nearly every remedy that I regard as essential to the 
abortive treatment of the disease in all of its various stages, 
also, because at this time I did not consider myself capable 
of writing an analytical thesis on the general treatment and 
consequently I wished to give myself more time for careful 
observation before doing so. In future, as my investiga- 
tions result in improved methods, I shall give the profession 
further details. I hope, also, to be able to go more fully 
into this part of my subject, in a paper which I propose to 
read at the San Francisco meeting of the American Medical 
Association. 

Admitting that typhoid fever can be aborted, it becomes 
a matter of prime importance to decide how to abort every 
case and save every life. This will be impossible as long as 
the people buy and use patent medicines, take domestic 
remedies, or for any reason neglect to send for a physician 
in season, and they will never realize the importance of do- 
ing this, so long as the physician fails to make a diagnosis, 
and institute proper treatment promptly as soon as he is 
called. 

Typhoid fever is man's most insidious enemy, having 
a long period of incubation, its early diagnosis becomes a 
matter of the greatest importance, and should invariably be 
made the first time the patient is seen, with sufficient ac- 
curacy to warrant the institution of proper treatment. I 
readily concede the impossibility of always making a correct 
or positive diagnosis at the first visit, but every case in 



72 CAN TYPHOID FEVER BE ABORTED. 

which the temperature is ever so slightly elevated, and the 
pulse ever so little accelerated, in which no contraindications 
can be discovered, should be prescribed for as a case of 
typhoid fever, thus giving the patient the benefit of every 
possible doubt, since I know of no disease or condition 
which under this rule would be unfavorably influenced; on 
the contrary,the diseases in which this course would be ideal 
treatment, are too many to be even mentioned in one short 
paper. In diphtheria, in measles, in variola, in malarial 
fever, in pneumonia, in influenza, and all catarrhal troubles, 
you have given your patient the best possible initial treat- 
ment. You will remember that I was assigned the duty of 
presenting a paper on "La Grippe," after its visitation 
amongst us in 1889, at the annual banquet of the Mahoning 
County Medical Society, in which I said that I accredited 
the fact that I had had no deaths from "la grippe," or any 
of its sequelae, to the treatment I had invariably pursued. 
I might have added, that although I had made no mistake 
in diagnosis, I regarded, for purposes of treatment, every 
case of " la grippe " as a case of typhoid fever except that I 
usually gave the remedies in larger doses Thus, while 
" la grippe " and typhoid fever differ so widely that I do 
not think any careful physician would be likely to make a 
mistake in diagnosis, these diseases are best treated in 
almost identically the same way, at least in their earlier 
stages, and the same is true of all of the malarial fevers, and 
of the so-called " typho-malarial fever." 

During my long and intimate association with my 
uncle, Dr. Timothy Dwight Woodbridge, to whom a niche 
is given in the temple of fame, whose prestige and super- 
eminence was undoubted, so distingue and dignified, he 
had dedicated his life to the healing of men, and his 
posthumous glory will ever shed a luster over the place 



CAN TYPHOID FEVER BE ABORTED. 73 

of his nativity. We of Ohio will always remember his in- 
exhaustable supply of intelligence and his well-stored 
mind, enriched by the observations and study of eighty 
years and more of life in this workaday world, and very 
nearly sixty years of active practice of medicine made him 
not only a pleasant companion and charming raconteur 
but always a wise guide and counselor in all matters re- 
lating to our profession. He has often said to me in his 
impressive way that there was no malarial fever in the 
Mahoning Valley which would ever cause a death even if 
left entirely without medical attendance, and yet the report 
of the health officer of the City of Youngstown for the past 
year, 1893, shows twelve deaths from malarial fever and 
only nine deaths from the more terrible and without ques- 
tion more fatal, typhoid fever. If Dr. Woodbridge, Sr., 
were right, and my own experience certainly sustains his 
boldly expressed opinions, then there are three horns, and 
three only, to the dilemma of the physicians who made these 
reports. In every one of these cases either a mistake of 
diagnosis was made, a false record submitted, or the medi- 
cine, and not the disease, killed these twelve patients. In 
this conclusion I am ably sustained by Dr. Eliot, of New 
Haven, who says : 

"When typhoid fever really exists, but is not correctly 
diagnosticated, it is in this vicinity most frequently called 
malarial fever, and at a later stage typho-malarial fever. 
This mistake generally depends upon a mixture of igno- 
rance and carelessness. I do not care to maintain, at the 
present time, that typho-malarial fever never occurs. I 
presume that every one is aware, however, that this term 
should be limited to cases of disease which are due to 
the simultaneous action of the typhoid and of the ma- 
larial poisons. I am thoroughly convinced that most cases 



74 CAN TYPHOID FEVER BE ABORTED. 

of so-called typho- malarial fever are in reality cases of 
typhoid fever. If a malarial element is present in some 
of them, it is possible to remove it promptly by appropriate 
treatment. With regard to cases of so-called malarial 
fever, it should be remembered, that most fevers which 
are caused by malarial poison, are of a distinctly inter- 
mittent or remittent type. If therefore, a case of con- 
tinuous fever occurs, which is uninfluenced by adequate doses 
of the ordinarily used anti-periodics, there is good reason 
for challenging the diagnostic accuracy of any one who 
pronounces such a case malarial fever. In most cases of 
this kind the disease is enteric fever. The vital statis- 
tics of our city and State show a number of deaths as 
due to malarial and typho-malarial fever, which is almost 
equal to the mortality reported from typhoid fever. There 
is little doubt that the majority of these cases reported, 
represent mistakes in diagnosis, where enteric fever has 
been overlooked and called by another name." 

The above quotation is perfectly applicable to this lo- 
cality, except that our statistics are worse than those of 
New Haven. Many more inaccuracies would have been 
recorded, had not the mistakes of the attending physician 
been corrected by the consulting physician, sometimes 
during the third or fourth week when it had become too 
late for a change in the medicine to benefit the patient, 
and there can be no doubt if these reports could be an- 
alyzed, and autopsies made, there would be found a large 
number of instances in which the deaths attributed to ma- 
larial fever should have been reported under another 
appellation. Osier, than whom there is perhaps no better 
authority, says in "Principles and Practice," these cases 
coming on with severe headache, photophobia, delirium, 
twitching of the muscles, and retraction of the head, are 



CAN TYPHOID FEVER BE ABORTED. 75 

almost invariably regarded as cerebro-spinal meningitis ; 
he says also that he has thrice performed autopsies on 
cases of this kind in which no suspicious symptom of ty- 
phoid fever had been present, and adds : " Cerebro- 
spinal meningitis is however a rare disease, typhoid fever 
a very common one, and the onset with severe nervous 
symptoms is by no means infrequent. Fully one-half of 
the cases of so-called brain fever belong to this category." 

Some of you may object to my method of making a di- 
agnosis ; may say that I reach conclusions from insufficient 
data. But you are reminded that this is a diagnosis for 
treatment only, and to be verified or corrected by future 
observations, and at the earliest possible moment, and that 
it can be justified only on the premise that the physician's 
most important duty is to cure his patient, rather than to 
strive for the unattainable — an absolute accuracy of diagno- 
sis. I am aware that an approach to an absolutely exact 
diagnosis in typhoid fever can be made, if the development 
of all the characteristic symptoms of the disease are awaited, 
but in this case the exact diagnosis is purchased at too high 
a price, and it will come too late to be salutary to the patient. 

It seems strange that so varied a value should be placed 
by different members of the profession upon the symptoms 
ordinarily supposed to be pathognomonic of typhoid fever. 
One will pin his faith to rose spots ; another to tenderness 
in the right iliac-fossae ; another attaches much importance 
to tympanitis, and dullness over the spleen ; while one old 
physician, who actually considers himself to be something of 
a luminary among the shining lights of the profession, says he 
never saw a case of typhoid fever in which there was not diar- 
rhoea, with little black spots through the discharges. He is 
on a par with those who fail in the discrimination and differ- 
entiation until their wits are awakened by the appearance 



76 CAN TYPHOID FEVER BE ABORTED. 

of rose spots, or the supervention of an intestinal haemor- 
rhage. Their diagnoses may be exact, indeed, but so far 
as any benefit to be derived from treatment is concerned, 
they might almost as well have been made in the dead 
house. A diagnosis of typhoid fever, based on such slight 
evidence as two symptoms only, and those common to 
many other pathologic conditions, might, and probably 
would, occasionally require future correction, but could 
never result in harm to the patient, because the remedies 
administered in the doses advised could by no possible 
means have any malific influence on any condition which 
could be mistaken for typhoid fever ; and the treatment par 
excellence for any stage of this disease would be almost 
equally beneficial in the early stages of any acute fever. If 
the appearance of these characteristic symptoms are awaited, 
typhoid fever will rarely be aborted, and unless made by an 
exceedingly expert diagnostician a very large percentage 
of this class of patients will be sacrificed. 

I hand you the chart of Case No. 51, Angus McP., 
which was shown with the records taken up to date, at the 
last meeting of this society. It was in this case that a fatal 
end was so confidently predicted by a physician who had 
examined him on the day after I first saw him. Pray ob- 
serve the rapid fall of temperature after each application of 
large doses of eucalyptol guaiacol mixture to the abdomen.* 
He had two or three small haemorrhages of the bowels. 

I was called to-day to see Mrs. A. McP., who un- 
doubtedly has typhoid fever. If so, hers will be an ex- 
ceedingly interesting case, since it will be complicated from 
the beginning, she having had extensive pelvic trouble 



*Dr. McCurdy, who saw Mr. McP. with me immediately after I was first 
called, during the discussion of this paper by the members of the County Society, 
said: " I consider this the worst case of typhoid fever I have ever seen." 



CAN TYPHOID FEVER BE ABORTED. 77 

since the birth of her child. Several nights ago she was 
called up, and stood on a cold oil-cloth, contracting a severe 
cold to which she accredited her violent headache and back- 
ache, cough and the agonizing pains in the region of the 
right nipple, and for this reason did not send for me un- 
til to-day. 

I shall report her case in my next paper. 

If in these preliminary papers I have convinced the 
medical profession that it is possible to cure typhoid fever, 
that in the future a death from the disease will be prima 
facie evidence of culpable ignorance, or criminal careless- 
ness, either on the part of the patient, his friends or his 
medical attendant; that the long weeks of burning fever, 
followed by a shattered constitution, and sometimes a 
clouded intellect, need no longer be feared. If I have im- 
pressed upon minds the importance of making an early diag- 
nosis and promptly acting upon it, have shown them the 
danger of mistaking typhoid fever for malarial fever or any 
of these milder diseases, and have clearly indicated that 
the scientific treatment of typhoid fever in its earliest stages 
is also the best possible treatment for any disease for 
which it is likely to be mistaken, then their time and mine, 
and the space these pages will occupy in the yournal of 
the American Medical Association, could be put to no 
better use. 

ADDENDA REPORT OF LATER CASES. 

Case No. 60. Mrs. Angus McP., aged twenty -four 
years. This case was first seen on the 1 2th of March. 
On the second day of treatment the temperature was 103^° 
and on the fifth day it was 104^°. The abdominal symptoms 
yielded promptly to treatment, but the trouble of the lungs 
grew rapidly worse,and culminated in a profuse haemorrhage 
of the right lung. The temperature on the 29th of March, 



78 CAN TYPHOID FEVER BE ABORTED. 

in the morning, had dropped to 97.8°, and in the evening, 
99.6°; the cough still very troublesome, but otherwise the pa- 
tient was quite well; had eaten a little beafsteak on the two 
preceding days. Thereafter her diet was left unrestricted. 

A brother, sister, and sister-in-law of Angus McP., all 
three having aided in nursing him, have each had an attack 
of typhoid fever. 

Case No. 63. Minnie McP. This case was first seen 
on the 14th of March. Although the symptoms were all 
characteristic, she was confined to the bed but little of the 
time. She was fanciful and capricious about her alimenta- 
tion, and although I warned her of the impropriety of eating 
solid food, she persuaded a little child to bring her three 
small cucumber pickles, which she ate, thus causing a severe 
attack of indigestion, at which time her temperature went 
up to 104°, after having been 99f ° the day before. How- 
ever, after the backset caused by this indiscretion, her con- 
dition improved rapidly and she was soon well. 

Cases Nos. 65 and 66. Frank McP. and Mrs. Hugh 
McP. Both of these cases presented characteristic symp- 
toms of typhoid fever, but as I was attending other patients 
in the house treatment was commenced early, and neither 
patient was confined to, bed more than a day or two. 

Case No. 59. Thomas M. Was under treatment and 
the case partially reported in my last paper. (See case No. 
55.) He continued to improve rapidly. The pulse having 
been on the second day of treatment 108, and the tempera- 
ture 1041°. On the tenth day of treatment, the tem- 
perature and pulse were reduced to normal. He sat up 
and ate a little beefsteak, and took no medicine after Feb- 
ruary 19, the thirteenth day. For fifteen days he was ap- 
parently entirely well, except that he did not regain his 
strength. I saw him on the eighteenth day, when his tem- 
perature and pulse were still normal ; he ate such food as 
he wished; walked out of doors each and every day, al- 
though he had not yet commenced to attend to his business. 
On the 3d of March I was recalled, and found the morn- 
ing temperature was 102.6°; the afternoon temperature 



CAN TYPHOID FEVER BE ABORTED. 



79 




104.8°, with a pulse of 112 to 116; although there 
were no rose spots, not much abdominal tenderness nor tym- 
panites, it was unquestionably a relapse of true typhoid 
fever. He recovered more slowly than from the first attack, 
his temperature first touching normal on the fourteenth day 
of treatment. Of cases that I have seen early in the dis- 
ease this is the first relapse I have ever had. 

Case No. 62. Annie M., sister of Case No. 59, resid- 
ing in the same house, consulted me on the 12th of March. 
She presented fairly well-marked symptoms of typhoid fever, 
except that the tenderness and pain in the right iliac fossae 
seemed to justify a diagnosis of a graver disease. She 
had been treated during the past summer for a disease 
which her physician denominated inflammation of the 
bowels. The development of a well-marked swelling in the 
painful and tender right iliac fossa, prompted me to call in 
consultation two eminent abdominal surgeons, Dr. McCurdy 
and Dr. Dickson, who both expressed the opinion that she 
had typhoid fever complicated with some grave pelvic 
trouble. Her temperature touched normal on the fourteenth 
day, and she made an excellent recovery from the fever. 
The secondary disorder was also perfectly cured in time. 



TYPHOID FEVER.* 



I have recently published in the Journal of the 
American Medical Association, three papers under the 
title, "Can Typhoid Fever be Aborted." These essays 
were accompanied by many clinical charts, containing 
much important data. They represented only a portion 
of the cases of typhoid fever which I have treated since 
the 25th of June, 1893, and of those only such as pre- 
sented absolutely characteristic and pathognomonic 
symptoms of the disease. Had I preserved complete 
memoranda of all of the cases which I have treated since 
1876, when I first realized that the text-books on the 
principles and practice of medicine were unsafe guides 
in the treatment of this most formidable disease; since 
1880, when I first undertook to introduce to my local 
society my novel and at that period almost untried treat- 
ment (for what are four years in the cycles of error dur- 
ing which typhoid fever has been regarded as an incur- 
able malady), or even since 1882, the year when I had 
my last death from typhoid, malarial, or any continued 
fever, I would now be in a position to present to you 
such a multiplicity of facts in evidence, such a profusion 
of records, such an array of incontestable proof as to 
have rendered all the vicious reasoning and wrangling, 
all the disputatious debates, all the illogical and flimsy 
argumentations that have assailed me to be set at 



*Read before the Buffalo Medical Club, 25th of April, 1894. Revised 1895. 

8o 



TYPHOID FEVER. 81 

naught. For the cases which I have treated have been 
so many and the results of the peculiar medication so re- 
markable that should a man from mere curiosity be 
tempted to thoroughly examine even these comparatively 
few records which are placed before the members of this 
society, should his mind be filled with doubt and in- 
credulity, should he be influenced by prejudice and mis- 
judgment, should his opinions be warped and biased by 
jealousy or enviousness; or should he be a man of such 
decision of character that this trait amounts to obstinacy, 
a man with the " idee fixe," or narrow-minded and hyper- 
critical, ready to fly in the face of facts; should he be 
careless and superficial, of a hesitating and undemon- 
strative disposition, lacking in faith and hope; skeptical, 
suspicious; should his ignorance and illiterateness render 
him incapable of adjudication, no man in any condition 
could but be absolutely impressed and imbued with the 
positively convincing proof which I have to offer that 
typhoid fever can be aborted. I fully realize the danger 
of drawing conclusions from insufficient data in such a 
disease as that under consideration, and for that reason 
I again express my deep regret that I wasted so much 
valuable material that would have aided me in convincing 
you of the truth of my statements. 

I am speaking well within bounds when I say that 
typhoid fever is far more amenable to treatment than is 
a large class of the milder diseases, of the curability of 
which there is no question. If it were in my power to 
communicate to all of you who sit beneath the sound of 
my voice to-night, the absolute confidence which I feel 
on approaching every case of typhoid fever (which I see 
at a sufficiently early date), it would give the conscien- 



82 TYPHOID FEVER. 

tious and ingenuous physician almost as much comfort 
and peace of mind as it would the patient. 

Some two weeks since I visited two of your great 
hospitals, where I was received in a most cordial and 
gracious manner by the physicians in charge. The 
typhoid fever patients whom I saw had every appearance 
of doing as well as could be expected under the "expect- 
ant method," and although records seemed to show an 
exceptionally low death rate, there was not wanting 
most positive evidence that the disease is yet the same 
old enemy, so malevolent and sinister, so virulent and 
destructive, so lingering and protracted, which in my 
earlier professional career caused me so many hours of 
anxious anxiety and disquietude. In one of the hospitals 
the following remark was made, " We had two deaths 
last week from consolidation of the lung in the fourth 
week of the disease." I could with difficulty restrain 
myself from saying, "There should be no fourth week 
in typhoid fever," and as I gazed upon the weak and 
emaciated bodies, which showed so palpably the physical 
pain and discomfort through which they had passed; on 
the physiognomy upon which was so visibly and indelibly 
impressed the mental suffering, which is as excruciating 
as the other; when I thought of the martyrdom of the 
thirty-four or thirty-five periods of twenty-four hours 
each; of the restraint and coercion of this durance vile; 
when I remembered the long and weary days of watching 
and surveillance which needed " L' oeil du maitre " each 
and every instant of time, and of the strain and fatigue 
which the faithful and untiring nurse and body guard has 
had to endure, and how easily all of this might have been 
obviated. And again when told that the nutriment of 
these patients was to be nothing but milk, until the tern- 



TYPHOID FEVER. 83 

perature was normal, and after that only such alimenta- 
tion would be given as was contained in broths and 
other liquid foods, until the temperature had continued 
at the normal point for two weeks, and then a little raw 
egg was to be administered, I thought of my patients, 
who after the eighth or tenth day of the treatment 
(should there be no intestinal lesion) are allowed to eat 
beefsteak and eggs, and other nutritious and sustaining, 
and at the same time easily assimilated food, and I pitied 
these starving ones, so pinched with hunger, so parched 
with thirst; whose voracious appetites did not need to 
be titillated; for their mouths were already watering for 
the delicate and dainty contents of the larder, and my 
compassion and sympathy were rendered more poignant 
by the recollection of my own feelings of torment and 
agony under the same circumstances. 

Would that I could have cast a mystic spell over 
them or by an "open sesame" caused to appear before 
their saddened eyes the entrancing luxuries which 
should have been in store for them. The feast of plenty 
instead of physic, the bed of roses upon which to bask 
in the sunshine, instead of the weeks of invalidism spent 
in a sanitorium; the robust health and strength, the 
hale and hearty fresh lease of life, all that Hygeia should 
have bestowed upon them, instead of leaving them 
tainted and languishing and bedridden, while I was to 
go forth on life's pathway without the opportunity of 
rectifying the inconsistencies of a dogmatic age and pro- 
fession. 

The talisman is in my hand, the magic wand of a 
Chiron, which has placed before us the life and health 
giving elixir, the panacea for all the ills of typhoid fever. 
In 1876, four years before Eberth and Koch discovered 



84 TYPHOID FEVER. 

the bacillus typhosus, while attending some cases of the 
abortive type of typhoid fever, the oft recurring but al- 
ways new and interesting query presented itself to my 
mind: Could not such medication be employed in every 
case of microbic disease, as to cause the course of the 
malady to be so modified that it would in no sense be 
dangerous to life, and from that time to the present, 
these noisome, polluted, infectious diseases have been 
my life's study. My deliberation and contemplation on 
the subject has been deep; I pondered long over each in- 
significent feature; my faculties and senses were strained 
to the utmost; I took counsel from every source; I cher- 
ished each idea and thought as it came to me, and my 
interest and thirst for knowledge on this topic was in- 
satiable ; I read each and every thesis I could come 
across with scrupulous care, and as I studied the treat- 
ment of typhoid fever in the most scientific publications 
within my reach, I hoped from the sifting and dissecting 
of a multiplicity of authors to be able to extract the 
essence of wisdom; I made my examinations with the 
eye of an Argus; watched each result, neglected no tri- 
fling occurrence which could in any way cause me to 
alter my already formed conclusions, and for all these 
years of solid work I received my recompense, for I 
was rewarded by obtaining my long sought desideratum. 

If in all of the marvelously great field of medical 
literature there is one subject that should cause the 
blush of shame to tinge the cheek of every devotee at 
the shrine of /Esculapius, it is that veritable witch's 
caldron of medical writings upon the treatment of 
typhoid fever. 

Many scores of widely divergent plans of managing 
the disease have been advised, recommending the use 



TYPHOID FEVER. 85 

of so varied an assortment of drugs, that from them a 
fairly well-equipped apothecary shop might be stocked, 
and should the student, instead of following his favorite 
author, attempt to formulate a method of his own, from 
an indiscriminate course of reading on the subject, he 
would have a difficult task indeed. I think the gentle 
men who are present will agree with me when I say 
that many of the therapeutic agents that have been ad- 
vised are harmful, and many are also dangerous; while 
the crowning fact remains that no single method of 
treating typhoid fever has yet been able to commend 
itself to even a respectful minority of the profession. 
On one point, and one only, which bears any relation to 
the therapy of the disease are the great thinkers and 
writers of medical literature united, viz. : that no treat- 
ment whatever has any curative power. Of this fact 
the editorial on that subject in the Journal of the Ameri- 
can Medical Association of the 19th of August, 1893, in 
summing up the papers read at the previous meeting of 
the Association (quoted in full by me, in my first paper 
on Typhoid Fever, which was published in the journal 
of the 10th of February, 1894), is quite conclusive. But 
the redundancy of the remedies prescribed; the impos- 
sibility of reconciling the different methods advocated; 
the glaringly apparent inconsistency of the many theories 
advanced, and the fact that some of the therapeutic 
agents most enthusiastically put forward, actually aid 
the disease in its deadly work; all goes to prove that the 
great oracles are in this field at least mere novices. 
If all the theories upon the host of methods of treatment 
for typhoid fever with the divers claims as to the omnipo- 
tence of each by their advocates, could be gathered into 
one volume and published as a whole it would I fear 



86 TYPHOID FEVER. 

convict the medical profession of lunacy or worse. 
Let us abandon then this contradictory mass of in- 
consistencies. Let us recognize the fact that any treat- 
ment to be successful must seek to accomplish some- 
thing- more than merely to combat and overcome symp- 
toms as they present themselves. All men of master 
minds have already accepted the germ theory of typhoid 
fever, and are further agreed that the germs generally 
enter the system in the water or milk, or perhaps occa- 
sionally with some articles of food; when a congenial home 
is found in the stomach and small intestines they form 
colonies, multiply by myriads, then if not destroyed or 
dislodged and ejected, find their way into the general 
circulation, and finally into nearly all of the organs and 
tissues of the body, producing a series of symptoms and 
consequences which are so well known that even to 
mention them would be a waste of your valuable time. 
It is well recognized that not even a majority of the 
persons drinking water which has been the cause of an 
outbreak of typhoid fever are attacked by the disease, 
and it has been suggested that those who are not ailing 
do not receive into the system any of the germs. This 
is scarcely probable. In the imperfect state of our 
knowledge in this field we can but surmise. It seems 
to me to be far more likely that the germs enter into the 
system of a much larger number of individuals than are 
attacked by the disease; but for some reason (which I 
shall not attempt to discuss) they have not found an har- 
monious dwelling place, and hence have entered into a 
state of "innocuous desuetude," rather than that there 
were not enough of these same germs to go around. If 
this be true, then to prevent an attack of the disease en- 
tirely it would be only necessary to produce a like con- 



TYPHOID FEVER. 87 

dition in all stomachs. To cure the malady, however, 
after the germs have multiplied enough to develop suf- 
ficient typho-toxins to make their presence felt, more 
than this must be done. If this or any similar theory be 
correct, and the germ in any one case can be destroyed 
and the disease aborted, the logical conclusion must be ac- 
cepted that at the same stage of the disease in any other 
case it can also always be aborted. In my boyhood the 
literature placed within my reach was good indeed, and I 
early learned to accept with a boy's implicit faith all that 
I read on theological subjects; and the habit remaining 
with me after studying medicine I accepted the teach- 
ings of her text-books with the same unquestioning faith. 
A morbid condition of mind from which it was exceed- 
ingly difficult to free myself, and which threw many an 
impediment in my way, as for instance when hope 
would tell me that I was aborting typhoid fever, and I 
would read something that would ring all of the changes 
of the oft reiterated statement that such a thing was ab- 
solutely impossible, I would have to whistle very hard to 
keep my courage up. Then after a period of doubt and 
uncertainty, hope would again begin to dawn, I would 
run across some wise author, who would encoffin hope, 
drive the nail home, and clinch it with a calculation, 
showing the weight of an average man, and the enor- 
mous quantity of the antiseptic or germicide (always of 
course selecting the most poisonous) it would require to 
thoroughly asepticize this enormous mass; and as such a 
great amount of so noxious an agent would be incompat- 
ible with animal life, would imagine that he had settled 
the question forever, forgetting to realize that the germ 
finds its earliest habitat in man in the alimentary canal 
(and perhaps in only a very small part of it ), and that if 



88 TYPHOID FEVER. 

one can in the very beginning of the illness thoroughly 
asepticize this small portion, it is possible at once and 
most effectually to cure the patient. But even if the 
germ has spread farther, as would be shown by the en- 
largement of the spleen, rose spots, or other symptoms, 
its home and place of multiplication is still in the alimen- 
tary canal, and if by asepticizing this it is possible to 
cut off the supply train and reinforcements, the elimin- 
ants will rid the system of these germs, not so quickly 
of course as in the former instance, but without much 
danger to the life or long continued depression of the 
patient. 

In my previous papers on typhoid fever, I have 
demonstrated (as far as my limited number of cases of 
that disease are capable of doing), that it is sometimes 
possible to abort the disease as late as the eighth or tenth 
day of sickness. At so late a stage as this, however, no 
matter how thoroughly the alimentary canal is relieved 
of the virus producing germ, the course of the malady 
cannot at once be interrupted, because the system is 
already so completely saturated with the noxa and time 
will be required for its elimination. 

If I have not already taxed your patience too much, 
I should like to add a few words on the treatment of 
typhoid fever by referring to Case No. 67. George C, 
aged 10 years. You will see that I began the treatment 
on the 20th of March, 1894, when the temperature was 
102i°. His recovery was rapid, and he regained all of 
his former vigor of constitution.* . 

In addition to the ordinary antiseptic treatment, 
toward the end of the illness I ordered two or three tonic 



*The treatment of this case is cut out because it has since been much simpli- 
fied and improved. 



TYPHOID FEVER. 89 

doses of quinine, and as he had from the beginning an 
exceedingly troublesome cough, some ipecac, Wyeth's 
bronchitis tablets and other expectorants were exhibited. 

I regret that I have had to give the treatment of a 
single case of typhoid fever as I have done here, or of 
the three typical cases which were published in a former 
paper, instead of defining the laws by which I believe 
the curative treatment of the disease is governed. I 
concede the right of the medical profession to demand 
any knowledge that any member may possess, that can 
directly or indirectly benefit humanity, but I deny its 
right to insist that any member shall immolate himself on 
the altar of professional ethics by publishing half formed 
theories, misshapen thoughts or any ideas that are yet in 
embryo ; for, let me assure you, I have still much to learn 
on the abortive treatment of typhoid fever. 

I may be mistaken in my high conception of the duty 
of each member of the medical profession toward the hu- 
man race, as well as toward his professional brethren, 
but I believe that if another operator can perform a 
laparotomy better than I can, and it is possible to pro- 
cure his services, I operate and my patient dies, I am a 
murderer. If he can cure every case of pneumonia, and 
presents fairly conclusive evidence that he has not him- 
self been deceived, and I fail to avail myself of his supe- 
rior skill, and my patient dies, in the High Court, where 
eternal Justice rules, I will be held responsible for every 
life. Thus, is it not the duty of every member of the 
medical profession to secure the services of one who pre- 
sents the evidence, which I have presented here to-night, 
of his ability to abort so grave a disease as typhoid fever ? 

Do you ask me how ? There are two ways. Of 
course I should always be pleased to meet any member 



90 TYPHOID FEVER. 

of the Buffalo Medical Club in consultation over typhoid 
fever, and Youngstown is less than six hours away; but 
a higher duty devolves upon you, to prevail upon your 
citizens to expend a little of their wonderful wealth in 
building for me a hospital in which to treat typhoid fever 
by the "Woodbridge Method," stipulating that it shall 
be mine only so long as I can satisfy the members of this 
club, or some other equally learned and honorable body 
that I can save the life of every uncomplicated case of 
typhoid fever ; can reduce the duration of the disease by 
more than one-half, and can diminish its severity in as 
great a degree. 

May I picture the marvelous results that such a be- 
neficent deed would bring. It would ultimately wipe out 
your death rate from the disease. 

Instead of its victims being confined to the bed from 
twenty-five to thirty-fi>e days, the average confinement 
would be less than five days. * 

Instead of being only ready to return to their usual 
avocations in from sixteen to twenty weeks, they would 
be already at work in two or three. 

Instead of having to wait until the temperature was 
normal for a period of two weeks before they were al- 
lowed a " little raw egg'' they would eat and enjoy beef- 
steak in an average of less than ten days from the be- 
ginning of treatment. 

But this would not be all. Chicago, with her terrific 
death rate would send to you to learn the lesson, and so 
would Pittsburgh, Washington, St. Louis, and all other 
cities where the disease prevails ; and Buffalo would 
teach the best lesson the medical profession of the world 
has learned for a hundred years. 



TYPHOID FEVER.* 



The awful mortality from typhoid fever in Chicago, 
in Philadelphia, in Pittsburgh, in Washington, and in 
many other cities, and in many rural districts throughout 
the United States, and the recent outbreak of the dis- 
ease in St. Louis, in Buffalo, in Northern Michigan, in 
North Dakota, coupled with the well-known fact that 
this malady manifests a marked preference for the 
young and vigorous of both sexes, fully attest the im- 
portance of the subject. The interest of the medical 
profession in it is made clearly apparent by the 
enormous number of letters that have deluged my mail, 
since the publication of my first paper under the title 
" Can Typhoid Fever be Aborted ? " These letters, 
coming as they do from almost every part of the United 
States, and some from beyond its boundaries, indicate 
that this interest is general and widespread, while the 
misunderstanding of some of the simplest problems in- 
volved, exhibited by the criticisms of some of those who 
have essayed the discussion of my papers, together with 
the contradictory theories and irreconcilable inconsis- 
tencies of the writings upon the subject, demonstrate 
the necessity of rewriting the entire literature of typhoid 
fever. But it is too early to do that — our knowledge of 
bacteriology is yet too new to justify us in attempting 



*Read before the Ohio State Medical Society. Revised 1895. With clinical 

data. 

91 



92 TYPHOID FEVER. 

to write the etiology of this disease, nor are we possessed 
of such nice comprehension of the action of the alexi- 
pharmics as would give special value to a thesis on 
its therapeutics. We know, too, too many lessons which 
must be unlearned before we can study it properly and 
well, and the favored few who have abundance of mate- 
rial and the best opportunity for observation in the great 
hospitals, seem loath to give up the false doctrines that 
are now so dear to their hearts. 

Should they not rather keep pace with the workings 
of the scientists of these "fin de siecle " days — should 
they not attack many of the ancient legends and tradi- 
tions of the mediaeval era — give them an entire boule- 
versement and annihilate the grossest of these dark age 
errors totally and completely — and leave the minds of 
the rising generation of medicos free from the bias that 
has swerved the students of all the past ages from the 
truth. Because some eminent authority has said that 
typhoid fever cannot be aborted, it does not necessarily 
follow that all future ages must accept his "ipse dixit, " 
and because we have not yet learned why certain reme- 
dies produce given effects, shall we say that deeds ac- 
complished are deeds impossible. Until we are pos- 
sessed of more exact data in regard to bacteria and their 
ptomaines and the actions of the alexines, abstract 
reasoning is apt to be misleading. 

Hence I have striven to avoid the discussion of 
scientific problems and confined myself to the statement 
of facts which have been proven or are easily susceptible 
of proof. I believe that I shall accomplish the greatest 
good in the shortest time and ultimately benefit the 
greatest number, by first demonstrating that " typhoid 



TYPHOID FEVER. 93 

fever can be aborted" and leaving- the speculative dis- 
cussion of scientific questions to the future. 

I have read three papers in my local society of late, 
and in each I gave a short narrative of my work in rela- 
tion to the abortive treatment of typhoid fever up to the 
date at which it was presented. I also offered for in- 
spection clinical charts of all of those cases which 
showed pathognomic symptoms of the disease which 
were treated by the so-called antiseptic method since 
June of that year. I exhibited these charts. I made my 
statement that I had had no death for twelve years from 
typhoid, malarial, or any continued fever, and I made 
my claim that typhoid fever can be aborted and that it 
should never cause a death. My paper was discussed in 
the society, my charts were verified and my clinical 
data were endorsed by those physicians who had seen 
the cases with me. Very soon after the reading of the 
last of the series I was invited to read a short article on 
typhoid fever in a society whose individual members 
were men of high repute and great renown, whose sta- 
tus in the medical world was unsurpassed, most of 
whom were personally strangers to me, however. During 
the discussion of my paper my clinical charts were 
senselessly and ruthlessly criticised by a gentleman of 
undoubted ability, a choice master spirit of the world, 
and he spoke honestly when he said, "I have examined 
every one of them carefully, and with four or five possi- 
ble exceptions, there is not a 'typhoid fever curve' 
among them." 

Gentlemen, you are requested to examine these clin- 
ical charts, and in the meanwhile I will make this ex- 
planation, which ought to have been given in the society 
of which I speak. There are among them three or four 



94 TYPHOID FEVER. 

charts which represent cases in which absolutely pathog- 
nomic symptoms of typhoid fever were not observed. 
They were placed in the collection because these cases 
appeared among others of a severe type accompanied 
by many fatalities. They were diagnosticated as typhoid 
fever and the presumption is that had they not been 
seen early, and promptly and properly treated, they 
would sooner or later have developed characteristic 
symptoms of the disease. Many of these patients were 
examined by members of this society who confirmed my 
diagnosis, watched the treatment, and who are ready to 
verify its results, every one of whom is the peer of the 
gentleman who criticised the charts, and quite as compe- 
tent as he to make an exact diagnosis in typhoid fever, 
and when he said: "Not all the State of Ohio could 
convince me that these are the charts of cases of typhoid 
fever," "or that the temperature of a typhoid fever pa- 
tient could be brought to normal in so short a time/' he 
simply exposed his ignorance of the possibilities of anti- 
septic medicine, and placed himself on record on the 
wrong side of the question, and his oracular assertions 
should never have been made in the society. 

You are asked to examine them, and to accept them 
as typhoid fever charts, upon my diagnosis, with the ver- 
ification of these gentlemen and to study the " tempera- 
ture curve" as a "typhoid fever curve" modified by 
treatment. Had the curves which are drafted on these 
charts been so traced that they would have pleased my 
critics, they would lacked much of pleasing me, and had 
I been unable to modify the curve, and duplicate the 
modification in almost every instance, no possible reason 
would have existed for the presentation of these charts, 



TYPHOID FEVER. 95 

or indeed for my appearance before this distinguished 
audience. 

An analysis of these cases of typhoid fever will show- 
that many of them were put under treatment on the 
sixth, seventh, or eighth day of sickness, and two or 
three on the tenth day or later ; but a demonstration of 
the possibility of aborting typhoid fever as late as the 
eighth or tenth day of sickness must not be regarded 
as a claim that this disease can always be aborted at so 
late a date ; or as a justification of the dense ignorance, 
or criminal carelessness, or both, which are so often re- 
sponsible for incorrect or inexact diagnoses. Nothing 
can justify the correction of a diagnosis of malarial 
fever, or any other disease, to typhoid fever ; still less 
the allegation that any disease has "run into typhoid 
fever." 

In order to make an authentic and precise estimate 
of the value of my results, you will please bear in mind 
that nearly everything that the profession has regarded 
as essential to recovery from typhoid fever has been 
ignored. Very few of my private patients have had the 
advantage of the heedful care and watchfulness of 
trained nurses. No bathing or sponging has been 
ordered in ordinary cases, except in the case of very 
young children, when the temperature has remained 
very high for several days, and in such an instance, as 
in the case where I first saw the patient on the sixteenth 
day of sickness. In many cases no restrictions were 
given as to exercise, my patients were allowed to sit up, 
walk about, and even go out of doors, if they felt able 
to do so, and many of them have eaten solid food on the 
seventh or eighth day after treatment was begun. 

I am fast coming to the conclusion that no restric- 



96 



TYPHOID FEVER. 



tions whatever as to diet are necessary, when the pa- 
tients are properly treated from the beginning- of the 
malady, for with antiseptic treatment one never finds 
serious abdominal lesions. 

With my last paper, read on the twenty-fifth of April, 
1894, I presented charts of cases of typhoid fever 



UQnHnQUlHnQnHElQiUSEHDSnBCDQ 




Nativ&y ..... 

OccupatfJoru^. 
TtaricLence 




Treatment 






JteniH.. 



iQ4? 
103° 
102° 

101° 
100° 

99° 
! 98° 



Vtu/tflhs. 



is- 



a 



* 



Tt 



a 



2? 



n 



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Jo 



treated by my method up to that date, including that of 
case No. 71, whom I discharged as convalescent on that 
day, since which time I have had but two cases which 
developed absolutely pathognomonic symptoms of ty- 
phoid fever. These patients were the wife and son of 
Mr. W. W., residing in the adjoining county of Trum- 



TYPHOID FEVER. 



97 



bull, and I consider that they were of singular interest 
because I had two other patients who presented tolera- 
bly well-marked symptoms of the disease, in the houses 
on two sides of his residence, but whose recuperation 
was so rapid and decidedly satisfactory in all respects and 
because Mr. W. had previously lost a son and daughter 
from the disease. 




Case 1ST. 

' ■ ■ ., 

'ise.. - 

Notes afOhse 

NameJfa— Jtf. MM 

Age. smz?,. 

Natix^itt/ 

Occupation. _ 

Tle*ricLence _ _ 

Date ofadrrussion.. /rte**^ <£71.. 

"'Diet ' 



*ZL<* 



Trealnxenx, 



'iXjC^Cm*- 






^ZT 



Resalt- 




Case No. 72. James W., aged fourteen years. This 
case presented all of the most characteristic symptoms 
of typhoid fever. Intense headache, tympanitis, ten- 
derness and gurgling in right iliac fossa, rose spots, 
bronchial catarrh, nose bleed and delirium. I saw the 
boy first on the twenty-fourth of April, when the tern- 



98 TYPHOID FEVER. 

perature was 1031°. On the second day of treatment it 
was reduced to 1011°, but on the fourth day it went up to 
105°, from which time it rapidly went to normal on the 
eighth day of treatment. 

Case No. 75. Mrs. William W., mother of Case 
No. 72, James W. During the last few days of her 
son's illness this patient complained of fatigue and 
weariness, but being a remarkably energetic woman and 
self-sacrificing mother, she nursed her son until he was 
able to sit up each day and then consulted me about her- 
self. I found the same characteristic symptoms as were 
present in the case of her son, except that there was no 
nose bleed or delirium. To this case I ordered to be 
given, in addition to the usual antiseptic medicine, a few 
doses of magnesia, a little ipecac, and as she had not 
slept for four or five nights her husband gave her a 
twenty drop dose of tincture of opium. Her temperature 
after the first four days did not run high, but did not 
touch normal till the eleventh day. 

Cases Nos. 73 and 77. Pearl H. and Michael M., 
aged respectively eleven years and seventy years. 
These patients lived in houses on two sides of Cases 
Nos. 72 and 75, and presented tolerably well-marked 
symptoms of the disease, the temperature touching 
normal on the seventh day in each case.* 

I regret that I am as yet unable to give any rule or 
regulation by which one may know when the desidera- 
tum of my treatment has been attained. I am in the 
habit of watching the symptoms very diligently, but care- 
fully, and when satisfied that the patient is steadily im- 
proving, I diminish the size of the doses, or discontinue 
the medicine. I strive by extreme vigilance to make 
amends for what I lack in knowledge. 



*The treatment and the directions for the management of the disease in 
Cases Nos. 72 and 73 which was published with this paper originally, is cut out, 
because the formulas have been changed, and somewhat simplified, and all these 
directions are now given under the heading "Treatment" in this book. 



TYPHOID FEVER. 99 

There is no language strong enough to condemn the 
custom of making a composite diagnosis, as is habitually 
practiced in many localities. It is not at all an uncom- 
mon occurrence for practitioners to say that a patient has 
malarial fever, and a few days later, on the change of 
some symptom, to correct that diagnosis to typho- 
malarial fever, and at last when the patient has had 
haemorrhage from the bowels or is dying of exhaustion, to 
state that the disease has "run into typoid fever." This 
course is justly condemned by Dr. Gustavus Eliot, of 
New Haven ; and equally reprehensible is the custom of 
those physicians who await the development of one or 
more of the pathognomonic symptoms of the disease, 
such as enlargement of the spleen, rose spots, etc., 
before venturing an opinion as to the real disease, or 
beginning the proper antiseptic medication. Since the 
method of treatment I have advised in typoid fever is 
the most desirable and useful course to pursue in any 
malady for which it could be mistaken, and since the 
patient who has been put under this treatment early in 
the course of the disease need not go to bed or in any 
great degree be restricted or restrained in diet ; de- 
barred from social enjoyment ; or even be required to 
neglect or omit his attendance upon his business ; I 
should recommend that every doubtful illness of this 
sort be treated as a case of typhoid fever. 

If future developments demand an alteration of this 
diagnosis and method of treatment the patient will 
already have been benefited by the medicine given under 
the mistake, but if the diagnosis should prove to have 
been correctly made, his life will have been saved. 

I have been very severely criticised by some eminent 
authorities for having made such "exaggerated (?) as- 



100 TYPHOID FEVER. 

severations," considering the comparatively little expe- 
rience I have had in the treatment of typhoid fever, the 
one declaring to be premature that which the other con- 
demned as inexcusable procrastination, and in this con- 
nection, while one of my papers was under discussion in 
my local society, several months ago, one member said : 
" I think Dr. Woodbridge is responsible for a great 
many deaths, as he did not publish an account of this 
treatment, which is capable of producing such decidedly 
remarkable results, twelve years ago." To this I re- 
joined: "The gentleman should recall to his remem- 
brance the fact that I gave my ideas of the treatment of 
typhoid fever to the members of this society more than 
twelve years ago. The audience of physicians present 
at the meeing was very large, the gentleman himself 
being one of the number. Can he have forgotten that 
every member who took part in the debate most heartily 
condemned my theories ? No. The responsibility for 
the many deaths from typhoid fever must not be charged 
to me. 

All the leaders of thought in the medical profession 
are an unit in teaching that typhoid fever cannot be 
aborted. They have a perfect right to their opinion and 
as far as modern teachings are concerned they are 
probably correct. 

Mr. President, I speak thus plainly, because of the 
persistent efforts of two or three "captious critics " to em- 
barrass my work and because I wish to place the respon- 
sibility exactly where it belongs. 

I want it to be fully understood that I am ready to 
go wherever in the whole world typhoid fever claims a 
victim, take charge of and treat the sick ones and if I 
have a death from the disease I challenge the publica- 



TYPHOID FEVER. 101 

tion of- my failure in a single instance to do with anti- 
septic medicine, the wonders which I declare are possi- 
ble. The day of the disease on which I first began to 
treat the patient should also be noted as a most impor- 
tant factor in the measurement of the value of my dis- 
covery of the abortive treatment of typhoid fever. 

The importance of this subject cannot be overesti- 
mated. Should cholera, or smallpox, cause a few hun- 
dred deaths, the people would be up in arms against its 
insufficient health boards, and yet, according to Dr. Victor 
C. Vaughan, than whom there is no better authority, who 
says in an article published in the current issue of the 
Pharmaceutical Era: " About 50,000 people die an- 
nually in the United States from typhoid fever, and more 
than ten times that number are sick with this disease." 
A fearful and unnecessary sacrifice of life, and health, 
and strength when the disease can invariably be aborted 
and every patient saved. He says further : " We have 
no foreign foe who could possibly inflict upon us the in- 
jury, suffering and death which typhoid fever will cause 
during the next twelve months." 

Were this country threatened with an invasion of 
an enemy capable of destroying the lives of 50,000 of 
her people, and prostrating half a million more, for even 
the average duration of an attack of typhoid fever, 
treated by the symptomatic method ; and were a military 
man to present the evidence of his ability to defeat that 
foe that I have given you of my ability to save the 
country the awful suffering and tremendous loss of life 
and time caused by typhoid fever, the entire resources 
of the nation would be placed at his disposal, and now 
I ask you, does not the country owe me one typhoid 
fever hospital in which I may endeavor to alleviate a 



102 TYPHOID FEVER. 

little more suffering", and save a few more lives than it 
would be possible to do in the private practice of medi- 
cine. In this hospital I could demonstrate to the pro- 
fession that typhoid fever is really amenable to curative 
treatment. If the medical profession and the people 
can be made to recognize this disease by its earliest 
symptoms, and will send its victims to me, as soon as 
they make their appearance, I make you this solemn 
promise, that 1 will return to them every one of these 
unfortunates, without a death from typhoid fever, or its 
ordinary complications, or sequelae, with much less than 
one-half of the usual loss of time from the sickness, and 
with little or no impairment of the constitution. 



TYPHOID FEVER.* 



It was originally my intention to have made in this 
paper an effort to discuss, from the scientist's stand- 
point, the etiology and treatment of typhoid fever, but 
the positive expressions made, within the past few weeks, 
of the opinions of many of the greatest thinkers of the 
age, that typhoid fever cannot be aborted, and in fact 
that the internal exhibition of drugs can have no cura- 
tive effect, warns me that I have essayed enough and 
that this paper had better be devoted to strengthening 
the evidence that the claims already made are valid, and 
that I should avoid, as much as possible, the enlarging 
of the territory which I have to defend, alone and un- 
aided, by even one of my confreres or collaborators and 
co-helpers in the work which I have undertaken. 

I feel that I do not owe this section any apology for 
this change in my plan, because typhoid fever is a dis- 
ease of supreme importance to the medical profession ; 
because of its wide distribution, its long duration, its 
high mortality and because much dreaded as the disease 
now is, it is rapidly on the increase. 

A disease whose geographical distribution is limited 
by no boundary lines, whose germs may live indefinitely 
in the icebergs of the frozen north, and thrive in the 



"^Revised 1895. Read in the Section on Practice of Medicine, at the Forty- 
fifth Annual Meeting of the American Medical Association, held at San Francisco, 

June 5-8, 1894. 

103 



104 TYPHOID FEVER. 

torrid heat of the equator, cannot be accorded too much 
attention by this association, especially as the medical 
literature of our day is in such a chaotic state as to be 
exceedingly confusing to those who place any trust in 
it. A literature which is not at all creditable to the med- 
ical profession as long as its recommendations for the 
treatment of typhoid fever form such a medley of con- 
tradictions, from "armed expectancy" to the most he- 
roic exhibition of the most dangerous therapeutic agents ; 
from corrosive sublimate to the coal tar derivatives, 
almost every known poison meets with the approbation 
of some supporter or adherent. These various remedies 
and methods of treatment have most enthusiastic devo- 
tees, until finally, the materia medica having been taxed 
to the limit of endurance, a new class of enthusiasts has 
arisen, and now the bath tub and sponge, and the cold 
pack have their advocates who can see nothing but dire 
disaster in the use of any therapeutic agent except cold 
water. The most amusing were it not the most tragical 
publication that has ever issued from any press, is the 
Johns Hopkins Hospital Report, Vol. IV., No. 1, on 
" Typhoid Fever," which I have just received, in which 
the learned " Osier, the clinical oracle of three great 
cities," Professor of the Principles and Practice of Med- 
icine of the Johns Hopkins University, asserts, and I 
quote him literally: "Since typhoid fever like a major- 
ity of the specific infections runs a course uninfluenced 
by any known medicines, the duty of the physician is to 
see that the patient is properly nursed and fed and that 
dangerous symptoms, should they arise, are combated 
by appropriate remedies." "In hygienic and dietetic 
measures his activity is incessant ; so far as drugs are 
concerned his attitude is best expressed in the term 



TYPHOID FEVER. 105 

' armed expectancy,' giving no medicine simply because 
the patient has a fever ; nursing and diet are the sup- 
ports in which we trust, the essentials under all circum- 
stances, to which is added the cold bath when possible, 
or cold sponging for the antipyretic action and stimu- 
lating effect." "Medicines are not as a rule indicated." 
" No known drug shortens by a day the course of the 
fever." "No method of specific treatment or of anti- 
sepsis of the bowel has yet passed beyond the stage of 
primary laudation." 

During the past twelve months I have written 
papers under the title " Can Typhoid Fever be Aborted?" 
for the Mississippi! Valley Medical Association, the Ma- 
honing County and the Ohio State Medical Societies, 
and for the Buffalo Medical Club, in each of which I pre- 
sented such determinate and categorical evidence that 
typhoid fever can be aborted, that had it been offered to 
the men of any other profession save that, which in 
America's most cultured city, failed to recognize the dis- 
coverer of ether until he had lain for a generation in an 
unhonored grave, leaving his widow long in poverty and 
I fear, even in want ; and which in the most enlightened 
capitol of the old World, made the life of the discoverer 
of vaccination immeasurably burdensome, would have 
been accepted as absolutely conclusive testimony or 
proof that my narrations of my success are true, and of 
unerring certitude — nothing dubious or at random about 
them — all fair, square and above board, and each and 
every statement "as sure as fate." And any other 
coterie of men would have accepted my harbinger of the 
dawn of a happier day with a glad heart and would 
have heralded joyously the good tidings to the sufferers 
from typhoid fever, but my " conservative profession,' 



106 TYPHOID FEVER. 

with the immutableness of the laws of the Medes and 
Persians to govern and guide them — the conservative 
canons and codes which have been the standbys of their 
forefathers for several generations, must needs tarry 
awhile before permitting a transformation of their 
ideas. It has always done so. It has ever ac- 
cepted newly evolved scientific facts with caution 
and deliberation. The man of investigative turn 
of mind must have figures and facts to guide him. The 
man of his own mind must be approached gently and 
warily that he may not become precipitately prejudiced 
and by his hastily formed judgment or his bigotry or il- 
liberalness estop or dishearten a more progressive man 
in his philanthropic work. 

Again the credulous man owes to his patients and 
to himself that he adopts cautiously neoterical ideas. 
This profession, however, is " slow and sure " and when 
it is once thoroughly convinced that it has within its 
grasp the true " Catholicon," it will apply it with no 
niggard hand. Those who compose it are moderate, 
and judicious, with gumption and esprit in abundance, 
their wisdom and good plain common sense indicates an 
enlightenment of mind and largeness of heart which con- 
forms admirably with the magnanimousness of the work 
of human kindness which they have utidertaken. They 
belong to the profession that the late venerable Dr. 
Oliver Wendell Holmes alluded to when referring to a 
charge that in his writings he drew all his villains from 
the clerical and legal professions, said : " I am afraid I 
shall have to square accounts by writing one more story, 
with a physician figuring in it. I have long been look- 
ing in vain for such a one to serve as a model. I thought 
I had found a very excellent villain at one time, but it 



TYPHOID FEVER. 107 

turned out that he was no physician at all, only a — I mean 
not what we consider a practitioner of medicine. I will 
venture to propose a sentiment which, as I am not a work- 
ing- physician, need not include the proposer in its eulogy. 
The medical profession, so full of good people that its 
own story tellers have to go outside of it to find their 
villains." 

When I read my paper before the Buffalo Medical 
Club ; I was very careful to say nothing that could give 
offense ; unless umbrage were taken at the bare 
announcement that " Typhoid fever can be aborted," 
and yet my paper was most courteously, and I must say 
severely criticised, by every member of the club who took 
the trouble to speak, save the President who said : " The 
medical profession has always been very conservative, and 
has sometimes made itself ridiculous by rejecting new 
ideas that were afterward found to be true." 

The criticism of my paper which was read before the 
Ohio State Medical Society was highly gratifying to me. 
The discussion was opened by Dr. Collamore, who spoke 
in his happiest vein. The general tenor of the remarks 
were in favor of giving humane and progressive ideas a 
warm welcome and a fair trial. There was present but 
one member of the Mahoning County Medical Society 
from Youngstown, Dr. J. E. Cone, who said: ''Being 
from Dr. Woodbridge's town and society, I wish to state 
that we have had several 'fights' on this subject, and we 
have been watching his cases for several years to see if 
he could make his pledges good, but so far we have been 
unable to discover that he has made any failure or has 
had a death from typhoid fever. And we intend to con- 
tinue watching his cases in the future, and if he have a 
death we will report it." A little speech which read be- 



108 TYPHOID FEVER. 

tween the lines speaks volumes. Professor Murphy 
however spoke eloquently in adverse criticism, saying in 
substance, that there could be no curative treatment for 
typhoid fever, and that he doubted the correctness of 
the diagnosis and observation of any physician who as- 
serted that he was able to abort the disease. He said I 
shocked him when he heard that I allowed my patients 
to sit up, walk about, and even eat solid food ; that in 
his day and generation the pathology of medicine had 
been upset twice and was now undergoing its third 
change, and he added: "All that is old is not false, 
and all that is new is not true. I would beg my friend 
to be a little guarded in saying that he has cured so 
many cases of typhoid fever with this treatment." I shall 
not attempt to quote Dr. Murphy's words any farther, 
or essay the hopeless task of reproducing in the manner 
justly its due, or even describing his eloquent speech, 
but as I sat spellbound listening with admiration to his 
brilliant oratory, I could not help wishing that he could 
see the subject as I see it, and that he were speaking 
for, instead of against the right. At a later period he 
said: "Our dispute maybe narrowed down to a very 
small circle. Either your theory that typhoid fever can 
be aborted is erroneous or all the teachings of pathology 
are false/' To which I answered : " My theory is cor- 
rect and the pathology that cannot conform to it must 
fall." 

If the theory that typhoid fever is caused by a germ, 
be accepted, its corollary must also be accepted, that is, 
that the germ can be destroyed, and if in one receptacle 
or the alimentary canal of one patient, then as a legiti- 
mate sequence it can be destroyed in every receptacle. If 
the physician who accepts this theory is enabled to see 



TYPHOID FEVER. 109 

his patient sufficiently early in the course of the disease, 
and treats every suspicious case on the first appearance 
of suspicious symptoms, he will rarely see a case of 
typhoid fever and never a death from the disease. It 
must require the possession of overmuch temerity and 
audaucity to enable a man, however learned and omnis- 
cient, in , exalting his individual opinion above the evi- 
dence of the experience and enlightenment of years of 
study and investigation of the subject in question. One 
must be quite au courant in every respect and degree 
with the whole battle ground before one should impugn 
the calculations and inductions of the investigator. The 
sciolist and the tyro should hestitate before placing 
himself in the pathway of intelligent research and prog- 
ress. They suggest nothing, offer no new idea, give no 
word of hope, simply deny that that which has already 
been accomplished, is possible. Had they anything 
better to offer, each opinion should be carefully weighed, 
but when they oracularly assert that a course of treat- 
ment which they have never tried, or of which they have 
no knowledge, cannot abort typhoid fever, they are 
making records of which they may in the near future be 
ashamed, and when those whose education and achieve- 
ments in the world of science have raised them to ex- 
alted positions amongst the members of their profession 
repeat those oracular assertions they are simply lending 
their learning and the weight of their famous and illus- 
trious names to aid in retarding the coming of the day 
when typhoid fever shall cease to be at once the stigma 
and the despair of medicine. 

Since the unaided efforts of one man, however faith- 
fully and indefatigably he may pursue his investigations, 
must belong indeed in accumulating sufficient data upon 



110 TYPHOID FEVER. 

which to base a scientific discussion of a given subject, 
and longer in giving- such expression to a finished work 
as to command the attention and confidence of the great 
body of a profession which is peculiarly prone to look 
on anything new with much suspicion — in whose ranks 
are men of every grade and degree of intellect and educa- 
tion; men of the quickest and of the dullest comprehen- 
sion ; men whose minds are treasure houses of pantology ; 
and men who cannot differentiate between the tempera- 
ture "curves of typhoid and of malarial fever" or realize 
that there is anything worth knowing that their own 
feeble faculties have not already mastered. 

I therefore appeal to every member of the American 
Medical Association, and to every physician who treats 
a case of typhoid fever to second me in the accumulation 
of such data as shall lead us to a better knowledge of 
the etiology and the true pathology of typhoid fever and 
especially of the action of antiseptics in its treatment. 
For this purpose, and because I have been unable to 
find a clinical chart so arranged as to make the collec- 
tion of the necessary facts practicable and easy, I have 
devised one that will enable the busy practitioner to 
make his records valuable, with the least possible loss 
of time. 

In conclusion, I wish to call the attention of the med- 
ical profession quite briefly to the antiseptic treatment 
of typhoid fever according to the method I have advo- 
cated. This has already been published in the Journal 
of the American Medical Association and in The Tran- 
sactions of the Ohio State Medical Society. I hope to 
be able, when I have had larger experience to secure 
equally good results with simplified prescriptions, from 
which I have eliminated some of the ingredients which 



TYPHOID FEVER. \\\ 

give the formula such a complex and unscientific ap- 
pearance. No pretense is made that this is the only 
preparation which will cure or abort typhoid fever, nor 
that any or all of its component parts are necessarily es- 
sential — but thus far it has not failed me, and crude 
and unfinished as the mixture seems I know of nothing- 
better. 

No one must say that he has tried my method of 
treating typhoid fever and failed, who has not exhibited 
these identical mixtures, alternated as I have directed; 
nor must he interject any other remedy calculated to 
interfere with their effect. 

As the mixture is perfectly harmless, it may be ex- 
hibited in almost unlimited quantities. I always advise 
beginning the treatment with very minute doses and 
thus avoid too early catharsis. 

As I have already stated, and with all my heart, in a 
former paper, I am ready to go wherever in the wide 
world typhoid fever claims a victim, whether it be across 
the continent or over the ocean, and I challenge the 
publication of any failure on my part to do all that I as- 
sert to be possible in the treatment of typhoid fever. 



FURTHER REPORTS ON THE ABORTIVE 
TREATMENT OF TYPHOID FEVER.* 



When I accepted an invitation to present a paper at 
the last meeting of the Mississippi Valley Medical Asso- 
ciation, I selected for the title of my essay the question, 
''Can Typhoid Fever Be Aborted?" and answered it 
in the affirmative, thus antagonizing the teachings of the 
most learned professors in every medical college in the 
civilized world ; I knew that I should be severely criti- 
cised and that all of my friends and enemies would sit 
in judgment upon me and after much arbitration would 
bring in a verdict, pro or con, and this verdict would 
depend upon how conclusive the evidence might be that 
my views on the subject were correct. I fully realized, 
to use the words of a distinguished litterateur, that I 
might expect "to stand and sit and sleep on pin points 
for years to come. " 

Nothing, save the feeling that it was my bounden 
duty to prove my allegiance to my ungenerous profes- 
sion by sharing with it the guerdon I had won as a re- 
ward for my life's work, and the wish that theey might 
assist me in removing the moral responsibility it now 
bears upon its shoulders for every life sacrificed to 
typhoid fever, could have tempted me to take upon 
myself so ponderous a burden. 



*Read before the Mississippi Valley Medical Association at Hot Springs, 
Arkansas. Revised 1895. 



ABORTIVE TREATMENT. U3 

I look backward over the twelve years of my experi- 
ence with antiseptic medicine without a death from ty- 
phoid, malarial, or any continued fever, to a preceding- 
series of twelve years during- which time I had a death 
rate of about 17 per cent from typhoid fever alone; and 
from the present time, when my confreres are having no 
better results than I formerly had. 

On the seventeenth of July, 1893, I gave in my local 
society the names and residences of twenty-one patients 
(all of whom were familiar to the members) whose 
symptoms indicated and whom I had treated as cases of 
typhoid fever, by my antiseptic method, during the pre- 
ceding years, selecting them from the large number of 
whom I had seen, as especially interesting because of 
some peculiar circumstance or characteristic ; and I called 
the attention of my auditors to them because they were 
all diagnosticated and the disease verified by well-known 
and reputable physicians as typical cases of the disease, 
but of which I had unfortunately kept no particular 
records and therefore had few items to present of the 
cases. However, on the twenty-fifth of June, 1893, I in- 
stituted a series of clinical charts, numbering the first 
22, and presented at the last meeting of this society the 
charts of twenty cases of antiseptically treated typhoid 
fever, to show the modification of the "temperature 
curve " by treatment. 

I deem it my duty as a conscientious physician, de- 
siring only the welfare of mankind and the advancement 
of my profession to continue tabulating the reports of 
cases of typhoid fever falling under my observation. 
The many grateful letters and kindly words of encour- 
agement I have received from my confreres, and in cer- 
tain instances from the patients themselves, more than 



114 ABORTIVE TREATMENT. 

offset the intolerant phrases and unkindly criticisms 
which I have met with from others, who have not been 
so choice of their use of language. I have no feeling of 
unfriendliness for these persons, because I know that 
" truth being eternal will prevail," and that my critics of 
to-day will themselves eventually practice the antiseptic 
abortive treatment of typhoid fever, and in so doing will 
vindicate me in the position which I have been obliged 
to assume, as a logical sequence of the facts I have ob- 
served during the twenty-five or thirty long years of a 
life devoted to the practice of medicine. I hope, how- 
ever, by going annually before some great medical body 
to report the cases in which the fever has been aborted 
and to exhibit the clinical temperature charts of all cases 
treated during the intervening periods, premising that 
when I see the cases at a reasonably early stage of the 
disease I shall have no death to mar my record, that I 
may ultimately prove beyond the possibility of a doubt 
that I am not teaching the world to expect or demand 
more of my profession than it should do. Few of you 
realize the anxiety which fills one's mind when one 
stands before the tribunal of a representative body like 
this Mississippi Valley Medical Association, nerved and 
fortified to make one's utmost endeavor to extirpate and 
annihilate the sophistries that all the great teachers in 
this most learned of the professions, whose highest aim 
should be to mitigate human suffering and to save human 
life, have promulgated. This blind leading of the blind 
which in the one disease under consideration, costs more 
than 50,000 lives each year and unnumbered years of 
miserable physical torment and mental infelicity to hu- 
manity. 

Since the last meeting of the Mississippi Valley Med- 



ABORTIVE TREATMENT. 115 

ical Association in Indianapolis in October, 1893, I have 
treated alone, or in consultation, fifty-four cases of ty- 
phoid fever without a death and with an average duration 
of about twelve days' treatment. 

I had also a case of pneumo-typhus which made a most 
perfect recovery in the end, but was long in doing so. 
Three cases of typhoid fever sent by other physicians at late 
stages of the disease were also treated, one was first seen 
on the sixteenth day of the disease. I was called in con- 
sultation to see one case on the thirty-fourth day of sick- 
ness, when no treatment was needed ; and at another time 
to see a patient at a somewhat earlier period of the dis- 
ease, but found him dying of exhaustion, when no treatment 
was possible. In the Section of General Medicine at the 
meeting of the American Medical Association in San Fran- 
cisco, in June last, I reported my cases of typhoid fever up 
to and including case No. 75. 

Case No. 76. Grace J. W., aged ten years, pneumo- 
typhus. 

This case was in a desperate condition when I was 
called. She had been ill for ten days ; was coughing in- 
cessantly, raving wildly, and having a profuse haemorrhage 
of the lungs; her pulse was 100 ; her temperature 106.4°. 
She was treated as a simple case of typhoid fever, with the 
necessary additions in the later stage of the disease to meet 
the lung complication. She made a good though not rapid 
recovery, as you will see. She lost all of her hair. 

Case No. 77. Michael M., aged seventy years. Re- 
ported in a former paper. 

Case No. 78. John J., aged six years. 

This boy was treated until the tenth day of sickness by 
the family physician, under a first diagnosis of malarial 
fever, and when this was changed to typhoid fever, I was 



116 



ABORTIVE TREATMENT. 



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CASE 78 —Typhoid fever; name, J. J.; age, 6 years; residence, Darrow street; date of 
admission, July 26, 1894. Result, temperature normal on the ninth day. • 

sent for. Dr. M. V. Cunningham, who had- seen some 
practice in Chicago, expressed a desire to see my work, so 
I invited him to accompany me on my first visit. I asked 
him to examine the patient and make a diagnosis. He did 
so, remarking that he considered it atypical case of typhoid 
fever. Fearing his remark might frighten the boy's mother, 
who was a stranger to me, I said, "Madame, you need not 
be alarmed, there is no danger from typhoid fever if it be 
properly treated." To this she replied, "I have seen 
several of your cases, and know they all do well. ,, The 
temperature touched normal on the eighth day of treat- 
ment, but went up a trifle afterward. 



ABORTIVE TREATMENT. 117 

Case No. 79. Mary S., aged twenty years. 

This was the case of an exceedingly delicate anaemic 
girl. The temperature did not run high, and she was not 
confined to the bed all of the time. The symptoms were 
not well marked. 

Case No. 80. Levi B., aged twenty-one. 

This patient was far from well for eight days, and was 
found on July 31, lying in the straw in the stable, too sick 
to make his wants known. After four days he used a 
hammock hung under a tree to lie in during the day. On 
the ninth day of treatment he left for his home in the west, 
fully supplied with all the medicine he might need. I heard 
from him in about a week, and he said he reached his des- 
tination in safety and with little trouble. He had nose 
bleed and much tympanitis, and other well-marked symp- 
toms. 

Case No. 81. Patay H., aged seven years. 

This child was brought to my house each day by his 
mother (he lived but a short distance away). The symp- 
toms were all well marked, and rose spots abundant. 

Case No. 82. Ezra M., aged twenty-six years. 
American farmer. 

This patient was sent to the hospital from the adjoining 
County of Trumbull, by Dr. T. H. Stewart, of Church Hill. 
I commenced treatment on the 31st of August, one day 
before he was removed from his home, nine miles distant, 
in the ambulance. On this day, the symptoms becoming 
grave, Dr. Stewart feared to continue the treatment with- 
out the assistance of a trained nurse, an expense which the 
family could not afford, hence he was turned over to me on 
the tenth day of his sickness. 

I found the bowels very tympanitic ; tenderness in the 
right iliac fossa ; rose spots abundant ; tongue coated, with 



118 



ABORTIVE TREATMENT. 




CASE NO. 82. 

margins red. He was in the hospital ten days. I saw 
him one week later when he drove to my office, and re- 
turned to his home again on the same day, a distance of 
eighteen miles, Dr. Stewart having had charge of him in 
the interval. 

Case No. 83. Walter K., aged twenty years. 

The diagnosis of this case was made by one of the best 
practitioners in Ohio, who called me in consultation, and 
together we treated the patient until he made a good re- 
covery. 

Case No. 84. Mrs. Ett. S. S. 

This patient had been confined just two months before, 
and had not been in very robust health. The temperature 



ABORTIVE TREATMENT. 



119 



on the 12th of September was 105°, from which point it 
gradually descended to normal on the ninth day of treat- 
ment. 

Case No. 85. Carl S., aged ten years. (Nephew of 
Case No. 84.) . 

This boy lived in a neighborhood where there were 
several cases of typhoid fever. Was not confined to the 
bed all of any day, and although presenting well-marked 



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CASE NO. 85. 

symptoms of the disease, rode several times on his pony 
to my office to see me. The temperature on the 13th of 
September was 104.2°, and touched normal on the tenth 
day of treatment. The symptoms were all characteristic; 
headache very severe for several days before 1 saw him, 
epistaxis, bowels tender and tympanitic. 



120 



ABORTIVE TREATMENT. 



Case No. 86. Nellie H., aged seventeen years. 

This patient was taken sick at the home of her parents, 
but the physician recognizing the gravity of her condition, 
had her removed to her sister's house, which was in a 
healthier locality, and had her put to bed down stairs, say- 
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CASE NO. 86. 

till the twelfth day of sickness, prescribing corrosive sub- 
blimate and one of the coal tar derivatives ; enjoined perfect 
rest ; milk diet. 

I was called on the twelfth day, found a typical case of 
typhoid fever, and being unaware of the doctor's prognosis, 
I told the family that she would probably be better in four 



ABORTIVE TREATMENT. 



121 



or five days, and sitting up in ten days. Rose spots were 
abundant and* other symptoms were characteristic. The 
temperature on the fourth day of treatment was 103°, and 
eight days after it had gone to normal. One week later 
she developed a phlebitis, which greatly prolonged the 
sickness. 



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CASE NO. 87. 

The physician who called me in consultation to see 
Case No. 83 was himself called to see Case No. 87. Olle- 
son M. 

This patient was the fourth case of typhoid fever in the 
family, one of whom died after an intestinal haemorrhage. 
His nervous symptoms being very severe, the attending 



122 



ABORTIVE TREATMENT. 



physician asked for counsel, and Dr. Justice, of Poland, was 
called. After consulting, the two physicians went together 
to the family, and told them that Mr. M's symptoms were 
so very bad that they advised them to send for me in con- 
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CASE NO. 89. 

found the patient in an exceedingly precarious condition, 
but after a conference with the doctors I said: " There is 
no danger of a fatal termination. He will have a normal 
temperature in ten or twelve days;" and added, "there is 
not only no danger of death in this case, but there never is 
any danger of death from typhoid fever when taken at the 
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124 ABORTIVE TREATMENT. 

and his temperature was 105.2°, and his other symptoms 
were extremely grave, and I was not expected to see him 
again. My prognosis was verified by the result, for his 
temperature touched normal on the tenth day of treatment. 

Case No. 88. Cornelia G. Dr. Frazer's case. 

Case No. 89. Paul G., aged four and one-half years. 
(See chart.) 

This case was first seen on the 16th of October, 1894, 
when the child had nose bleed, severe headache, bowels 
very tympanitic, and was slightly delirious. On the twelfth 
day of treatment rose spots were abundant. On the 
eighteenth day he was playing out of doors, but was very 
cross and irritable. 

Case No. 90. Iva M. Dr. Udell's case. (See chart.) 

Case No. 91. Mrs. Alexander G. 

This patient was seen in consultation with her attending 
physician, Dr. Justice. Her urine showed large quantities 
of albumen, and had an abundance of both granular and 
hyaline casts. Her temperature never went above 101°. 
She had considerable intestinal haemorrhage, but made a 
good recovery. 

Case No. 93. Mrs. D., aged twenty-four years. 

When called to see this patient I was told that she 
had been sick about ten days, but later information led 
me to believe that she had been sick twelve or thirteen 
days. The sanitary surroundings were terrible ; her con- 
dition and circumstances horrible ; neither any part of the 
bedding nor her underwear were changed, nor were her 
hands or face or any part of her body washed during her 
sickness. On one of my visits I found the unemptied 
bedpan on the bed, and on inquiring found her bowels 
had moved on the morning of the preceding day. In no 
way were the ordinary demands of cleanliness attended 



ABORTIVE TREATMENT. 



125 



to. There was a cooking stove in a back kitchen, which 
was separated from the house, and no fire elsewhere ; it 
was cold weather, with snow most of the time. 

The room adjoining hers, separated from it by only a loose 
board partition, was scrubbed once, and when I went in 
I found water standing in puddles about the floor. 



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CASE NO. 93. 

Her husband was taken from her bedside to jail. When 
I first saw this patient she had intense headache ; no 
sleep for three or four nights ; very nervous ; abdomen 
tender and very tympanitic. She had three haemorrhages 
from the bowels on October 15, the fifth clay of treatment. 
She made as you see, a rapid recovery, her temperature 
becoming normal on the thirteenth day of treatment. She 



126 



ABORTIVE TREATMENT. 



lived so far in the country that I could not visit her every- 
day. 

Case No. 92. Mrs. J. O. Y., aged twenty-four years. 

This patient was the wife of Dr. J. O. Yost, of 
Hazelton, Ohio, and had been under the care of Dr. 
Bennett, a gentleman of unquestioned ability (who about 




CASE NO. 92. 

a year ago passed through a very severe ordeal with 
typhoid fever, was confined to his bed for six weeks, was 
unable to attend to business for an additional three months, 
and even yet has not gotten entirely over the effects of 
the attack). 

Seeing his patient growing worse, Dr. Bennett called 
upon me, and asked me to see her, on October 27, the 



ABORTIVE TREATMENT. 127 

tenth day of her illness. I found, as he said, a typical 
case of typhoid fever; the temperature 104^°; the pulse 
varying between 110 and 134 and which later in the 
disease became dicrotic. The bowels were very tender 
and tympanitic ; marked dullness over the spleen ; the 
margins of the tongue red, the center coated ; much 
gurgling on pressure ; a few rose spots, which afterward 
became abundant ; nervous and sleepless ; and very severe 
headache. The temperature touched normal on the tenth 
day of treatment. During my first visit, both Dr. Bennett 
and Dr. Yost asked me if I considered Mrs. Yost in very 
great danger. I answered giving my usual prognosis 
" typhoid fever is never dangerous if properly treated at 
the commencement of the disease." 

Case No. 94. Dr. J. O. Y., (Husband of Case 
No. 92.) 

October 29th, two days after my first visit to Mrs. 
Yost, Dr. Bennett called my attention to Dr. Yost, 
saying that he believed that the Doctor had typhoid 
fever. 

On examining him, I found his symptoms nearly as 
well marked as were those of Mrs. Yost, save that his 
temperature and pulse were not so high nor frequent, and 
he had no rose spots. He at once said that if he were 
going to be confined to bed, he should go home. I 
replied: "Stay at home and attend to your practice. I 
assure you that you will be able at least to see patients 
in your office every day of your sickness." And he was. 

Case No. 96. Kittie Y., (Sister of Case No. 94.) 

On November 3, five days after her brother was taken 
ill, this patient was attacked with typhoid fever. She did 
not say any thing about being ill until she was no longer 
able to sit up. Her temperature on the day before 1 saw 



128 



ABORTIVE TREATMENT. 



her was 104^° her pulse 100, and all the symptoms 
characteristic. On November 2 she had severe headache, 
her cough was incessant, her abdomen tympanitic and 
tender and pressure produced gurgling. I told the Doctor 
that she would have to stay in bed three or four days, 
perhaps, but would be well in ten days and could eat 
solid food all of the time. 



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CASE NO. 96. 

At the time of the illness from typhoid fever of the 
family of Dr. Yost, a man who lived in a boarding house 
near by, died, and the necropsy revealed extensive typhoid 
lesions, and a perforation of the intestines. 

Case No. 95. Miss K. This case presented char- 
acteristic symptoms of the disease, severe headache ; 



ABORTIVE TREATMENT. 129 

tympanitis, etc. She was not confined to her bed all of 
the time, and recovered rapidly. 

This closes the record of those cases of typhoid fever 
which I have treated since the last meeting of this Society. 
Some of these patients, whose complaint was diagnosticated 
and treated as typhoid fever, may possibly have been ill 
with some other fever, but whatever was the infirmity, 
they all recovered under the abortive treatment of typhoid 
fever. This manner of managing the disease is the least 
harmful and most salutary they could have had ; there 
being nothing in it that could possibly be injurious to the 
health in any condition, 'in the doses which I have described 
and it would be invariably beneficial in all disease of a 
microbic origin. 

No sane man would have the fool-hardiness to dare 
to enter the abode of his patients, with two or three 
members of the family ill with typhoid fever (the temper- 
ature of some of the patients being above 105° F.) 
and give this one invariable prognosis, unless he were 
perfectly cognizant with the fact that there was some 
invincible power in medicine to ward off the threatened 
danger. No man would be imprudent and incautious 
enough to dare to make the promises that I have made 
for so many years, unless he knew whereof he spoke and 
that he could triumphantly fulfill them. 

Remember, I have invited the most unremitting scrutiny 
of my cases while under treatment, and should I have 
a death from typhoid fever or should I fail to abort a 
case, in which I had commenced the treatment early in 
the disease, this fact would be emblazoned all over this 
broad land. Had I twenty years, instead of this fleeting 
twenty minutes, and could I take you back through the 
past twelve years of investigation, and present to your 



130 ABORTIVE TREATMENT. 

view all of the miscellany of evidence that has proved to 
me that typhoid fever can be aborted ; could I enumerate 
for you all the typical cases that have yielded so facilely 
and submissively to this intestinal antisepsis ; point out 
the awful complications that have menaced life ; show you 
the white haired old lady, whose symptoms denoted most 
positively the proof that she had a pre-existing Bright's 
disease, and the repeated intestinal haemorrhage that her 
acute malady was typhoid fever of the most perilous and 
terrifying type ; show you the venerable old man of 73 
years of age, whose beloved young son had succumbed 
to fatal intestinal haemorrhage ; could I let you look upon 
the young lady, with the year old ovarian trouble, pre- 
senting a rounded fluctuating mass through the abdominal 
walls ; could you see the wife of Angus McPhee, with 
the blood welling up from her lungs and could I show you, 
as in a kaleidoscope, all of these patients restored to hale 
and vigorous health in a few days, after having been, during 
the illness in many instances, surrounded by the most un- 
sanitary conditions and much of the usual routine of the 
sick room, which of old, has been invariably insisted upon 
as essential to recovery from typhoid fever being disregarded 
and sometimes totally dispensed with. Many of these 
patients had only such nursing as a young child could give. 
In some cases, no restrictions in regard to diet were made, 
and all were allowed to use their own pleasure as to exercise 
(when there had been no serious intestinal lesion) and 
bathing and yet I can show you that I have had no death to 
mar my record. 

You should commend my course in making so great a 
sacrifice, and even endangering my professional career in the 
interest of humanity, by placing myself in the unenviable 
position of one who fixed a higher standard of responsibility 
for his profession than it was ready to accept. 



ABORTIVE TREATMENT. \\\\ 

In the abortive treatment of typhoid fever an early 
diagnosis is of the first importance. Every case of the dis- 
ease should be put upon proper treatment the first time it 
is seen by the physician. There should be absolutely no 
exception to this rule. If you await the development of 
pathognomonic symptoms of typhoid fever before beginning 
treatment you will not always succeed in aborting the dis- 
ease. Therefore a change of diagnosis from any other dis- 
ease to typhoid fever is wholly unjustifiable ; but the reverse 
is always proper, because the best possible treatment for 
typhoid fever is also a safe initial treatment for any disease 
for which it could be mistaken. 

If you always begin proper treatment when you first see 
your patient, he will often be well before a positive diagno- 
sis is possible, and you will be deprived of what might 
otherwise have been a valuable record of a case of typhoid 
fever, but your patient will be the gainer, and after all we are 
physicians first and investigators afterward. Hence, when 
consulted by a patient who could possibly become a victim 
of typhoid fever, diphtheria, influenza, pneumonia or any 
pathologic condition which would be benefited by an intes- 
tinal or systemic antiseptic or eliminant, begin at once the 
treatment for typhoid fever. 

It must not be supposed that because I have been able 
to begin the treatment at almost every stage of the disease 
in the large number of cases I have treated and have had 
no death from typhoid fever or any disease that could be 
mistaken for it for more than twelve years, that such results 
are always possible. These cases make the proof positive 
that typhoid fever can be aborted, but it does not follow 
that it can always be aborted or even that every life can be 
saved when the disease has not been properly treated in its 
earliest stages. Next in importance to an early diagnosis, 



132 ABORTIVE TREATMENT. 

if indeed it should not stand first, is that your prescriptions 
be properly compounded, of pure and active ingredients, 
for upon the freshness, purity, activity and proper prepara- 
tion and combination of the drugs, as much as upon their 
administration, depends the physician's ability to abort 
typhoid fever. I was, myself, long in learning this import- 
ant lesson, and longer in learning upon whom to depend for 
the preparation of remedies that would contain neither inert 
nor irritant constituents. Messrs. Parke, Davis & Co., of 
Detroit, Michigan, have for many years supplied most of 
the materials entering into my prescriptions, and latterly 
they have put up for me tablets of formulas Nos. 1 and 
2 ; soft capsules of formula No. 3 ; and for children, tab- 
lets of Formula No. 4, and soft capsules of formula No. 5. 
Their work has been done in a most satisfactory manner, 
and by long experience I have learned to rely upon their 
preparations so implicitly that I would not feel justified in 
possibly endangering the lives of my patients by experiment- 
ing with the products of other manufacturers. 

This antiseptic treatment of typhoid fever, commenced 
in an early stage of the disease and intelligently carried out, 
will, if the remedies be pure, active, and properly prepared, 
abort typhoid fever ; and if used universally by the medical 
profession a death from the disease will be unknown. 



*The treatment has been cut out of all these papers because it has been 
modified and simplified. 



TYPHOID FEVER IN CHILDREN.* 



Typhoid fever is the same disease, is produced by the 
same causes and is governed by the same laws, at whatever 
time of life it may occur, from earliest infancy to the frailest 
anility; modified as it may be, by age, by organic develop- 
ment, by concurrent affections, or by extrinsic causes, and 
probably by the quantity of poison ingested. In the child as 
in the adult, it is caused by the same morbific influence, 
which can be neutralized by the same antidotes. In either 
instance the patient should be regarded and treated simply 
as the container of the specific poison. 

It follows, that notwithstanding the minor modifications 
which the character of the disease may undergo, on account 
of age or other causes, that it is amenable to practically the 
same curative treatment in infancy as in adult life. 

I must, therefore, make the same declaration here that 
I have made in every medical society before which I have 
discussed typhoid fever since 1880, viz., that every case can 
be aborted and that death is a wholly unnecessary conse- 
quence of the disease ; and farther, that these results are 
attainable by a treatment so mild and gentle that, should the 
newborn babe be given the dose intended for robust man- 
hood no harm would result ; or should the child, overfond 
of its medicine, take at once the portion intended for fifty 
doses, it need cause no anxiety. 



* Read in the Section on Diseases of Children, at the Forty-sixth Annual 
Meeting of the American Medical Association, at Baltimore, Md., May 7-10, 1895. 



133 



134 TYPHOID FEVER IN CHILDREN. 

Yet symptomatically treated, typhoid fever is one of the 
most serious affections of infancy and early child life ; 
and in the most alarming- forms of the disease, in which the 
fever rises rapidly to an excessive height and the nervous 
symptoms point to some grave cerebral lesion, the true 
character of the ailment is rarely recognized in time to 
benefit the patient. Indeed, in a very large majority of these 
cases a correct diagnosis is never made. Therefore, while 
treating of typhoid fever in the adult, my pleading has 
always been for an early diagnosis. In discussing typhoid 
fever in children, the burden of my plea must be for a correct 
diagnosis; since the disease in babyhood is so frequently 
overlooked. 

While Murchison and other eminent authorities have 
recognized and acknowledged the possibility of the occur- 
rence of typhoid fever in earliest infancy, and even during 
utero-gestation, yet neither the best text-books, the teachers 
in the medical colleges nor the general practitioner have 
realized how frequently the disease occurs in desperate 
forms during early childhood. 

Reynold's "System of Medicine" devotes more than 
seventy-five pages to typhoid fever and does not mention 
the disease in children in the whole article. Pepper's 
" System of Medicine," in five large volumes, justly praised 
wherever the English language is spoken, yields less than 
two dozen lines out of more than one hundred pages on 
typhoid fever to the disease in children. Professor Osier, 
whose "Principles and Practice of Medicine" is perhaps 
more largely quoted than any other work on the subject, 
disposes of typhoid fever in children in less than one dozen 
lines, and this is the author who says: " Cases (of typhoid 
fever) coming on with severe headache, photophobia, de- 
lirium, twitching of the muscles and retraction of the head 



TYPHOID FEVER IN CHILDREN. 135 

are almost invariably regarded as cerebro-spinal meningi- 
tis." And again, " I have thrice performed autopsies on 
cases of this kind, in which no suspicion of typhoid fever 
had been present ; the intense cerebro-spinal manifestations 
having dominated the scene. * * * Cerebro-spinal 
meningitis is, however, a rare disease ; typhoid fever a very 
common one, and the onset with severe nervous symptoms 
is by no means infrequent. Fully one-half of the cases of 
the so-called brain fever belong to this category." 

But while medical literature has recognized the possible 
predominance of the nervous symptoms of typhoid fever in 
the adult, it has failed to give due warning of the frequency 
with which these symptoms occur as the most prominent 
manifestations of the disease in early childhood, an omission 
which has been responsible for many errors in diagnosis 
and treatment. 

In the first number of the Journal of the American 
Medical Association for this year, 1895, a distinguished pro- 
fessor of the diseases of children says that : "It has been my 
good or ill fortune to see during the past ten years, a num- 
ber of cases in children under the age of two years which 
presented mild intestinal disturbance, no marked tenderness 
over the bowels, a very high temperature, and where the 
apparent cerebral complications, delirium and stupor being 
prominent symptoms, were the apparent cause of death 
In these cases, in the death certificate, the cause of death 
was usually given as congestive fever or meningitis. Two 
of these cases occurring within the past year, in both ol 
which the post-mortem examinations revealed a pronounced 
error of diagnosis, has emphasized in my mind the thought 
that typhoid fever exists more frequently in early child life 
and in a serious form than is generally suspected 1 present 
the folio win or case: 

«3 



136 TYPHOID FEVER IN CHILDREN, 

"A little girl of eighteen months, the child of a very 
prominent physician, was taken sick early in May, with 
marked intestinal disturbances ; the evacuations from the 
bowels were frequent and copious, accompanied by mucus 
and blood. The temperature ranged from 102° to 104°, 
and on one occasion reached 105°. There seemed to be a 
history of acute indigestion. The usual treatment was 
applied in this direction, and the temperature was controlled 
by cooling baths. Flushing of the colon with medicated 
warm water was applied, followed by starch water injections 
containing a few drops of laudanum, for the purpose of 
calming and reducing the frequency of the operations, which 
interfered with sleep. During the early part of the attack, 
the child, though having frequent operations, was noticed 
to be calm and gave no evidence of pain. Not until the 
fourth day, however, was marked obtundity observed, and 
the staring appearance of the eyes, together with the in- 
difference to surroundings, impressed me with the fact that 
there was a cerebral complication. The course of the 
treatment was continued and the supposed cerebral com- 
plication became more pronounced. Inability to distinguish 
light or sound, and a crossing of the eyes, apparently 
justifying a diagnosis of meningitis. The child died about 
the tenth day. Post-mortem examination developed the 
absence of meningeal inflammation and the presence of 
ulcerations of the glands of Peyer, showing us, the physi- 
cians in attendance, how little we knew of the cause of 
death." 

The author adds : " The indications for treatment were 
the same. A recognition of the disease in advance would 
probably have made no difference." 

I have quoted thus largely from this paper because it is 
really a valuable contribution to medical literature, and I 
honor the learned author for giving less enlightened mem- 
bers of the profession the benefit of the many sad experi- 
ences which have finally opened his eyes to the fact that he 
has been stupidly floundering in his differentiation of dis- 



TYPHOID FEVER IN CHILDREN. \\\- 

eases, albeit he has yet to learn of his greater deficiency 
in knowledge of the treatment of typhoid fever. I fore- 
go all criticism on the long years and the number of 
pronounced errors of diagnosis which were required to im- 
plant in his mind a just conception of the vast number of 
children who must die annually of typhoid fever, after 
having been treated by the average practitioner for acute 
indigestion, and later for meningitis, and finally are buried 
under a false death certificate. If this article, by one of the 
world's most distinguished professors and medical editors, 
truly represents the practice of tr^e class to which he be- 
longs, it paints a sad picture of the little victims of typhoid 
fever who were so unfortunate as to have come under 
their skillful care. It presents to our view what costly mis- 
takes these illustrious gentlemen make, and yet the author 
eliminates but one or two of the diseases with which, in 
infancy and early childhood, typhoid fever is so often con- 
founded. 

With our present knowledge of the causes which pro- 
duce typhoid fever and the susceptibility of young children 
to their influence, taken in connection with the exceedingly 
limited number of cases of the disease which are reported 
to the various health departments in our cities where the 
disease prevails, it must be evident that the eminent writer 
of the paper quoted is not the only physician who should 
have had the fact emphasized in his mind "that typhoid 
fever exists more frequently in early child life and in a more 
serious form than is generally suspected." 

I have in consultation seen typhoid \v\c\- in young 
children mistaken for malarial fever, pneumonia, cholera in- 
fantum, teething, and even for worms, in addition to menin- 
gitis and acute indigestion. 

The diagnosis of typhoid fever in children as in adults 



138 TYPHOID FEVER IN CHILDREN. 

should be made by reasoning by exclusion, and if thus the 
disease cannot be eliminated from the patient's possible 
ailments, the case should be treated as typhoid fever, be- 
cause no other disease is so insidious in its character ; be- 
cause no other disease is so amenable to treatment in its 
earlier stages and so intractable after its anatomic lesions 
have reached a certain stage ; because it is so often impos- 
sible to make a positive diagnosis in time to save the 
patient's life ; and finally because the best treatment we yet 
know for typhoid fever not only fulfills both of the require- 
ments of Hippocrates ; it is curative, it is harmless in health 
or in any pathologic condition at all resembling the disease 
for which it is instituted. 

I learned the importance of making a correct diagnosis 
in typhoid fever many years ago, and in 1881 I was taught 
a lesson on the management of the disease in children 
which I shall never forget. 

Little Gracie Wick, aged three years and ten months, 
was taken sick on December 14. Her temperature on my 
first visit was 105°. In fourteen days she died of typhoid 
fever. A few weeks later her younger sister Emily, aged 
two years and ten months, was attacked by the disease, 
which ran a parallel course and ended in death, again on 
the fourteenth day. Both children presented abdominal 
symptoms. In both the nervous symptoms predominated. 
Both had opisthotonos, and both died the victims of almost 
criminal stupidity on my part. They were my last two 
fatal cases of typhoid fever, and to-day should I be called 
as promptly as I was then, they would have been in no 
danger of dying. 

Looking back to those gloomy days, I cannot realize 
why I let those children die, for I knew well enough how to 
treat typhoid fever in adults even then. I made a very in- 
adequate effort to assuage the pangs of conscience by call- 
ing two of the oldest and ablest physicians of the city in 



TYPHOID FEVER IN CHIIDREN. 



139 



consultation after the time had passed when counsel could 
have been of any avail. 

As a marked contrast to the sad picture portrayed by 
the death of these little ones, my last two fatal cases, I wish 
to present the clinical charts of a few of the cases of 
typhoid fever I have treated during the intervening years 



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CASE NO. 105. 

and relate the annals that have been kept of them, and as 
an addendum give the records of a few cases treated by 
other physicians, by that which for want of a better name I 
have designated antiseptic medicine, for it is antiseptic 
medicine, and it is also something more. 

Case No. 105. Annie W., aged three years. (Cousin 
of Case 78, John J.) I was called to see this patient on 



140 TYPHOID FEVER IN CHILDREN. 

February 7, and given the following- history : She had 
been sick eight days, had been treated by an irregular phy- 
sician, under a diagnosis of malarial fever until the parents, 
alarmed by the severe symptoms, continued high fever and 
the enormous tympanitic distention, questioned him closely 
as to the nature of the disease, finally eliciting from him 
an admission that it might be typhoid fever, when he was 
promptly discharged. I found the temperature 105.5°, 
pulse 140, on the evening of my first visit, and the same 
the next morning; the parents having about given up 
hope, as the child was thought to be dying twice during 
the night preceding my first visit, There was marked im- 
pairment of vision, deafness, and well-marked retraction of 
the head. When asked if I entertained any hope for the 
life of the child I gave my usual favorable prognosis, say- 
ing: " I think the child will recover, and she certainly will 
if she survive the next forty-eight hours." She had intes- 
tinal haemorrhage, which in my experience is rare in young 
children. She also lost all power of speech, her lower 
limbs were paralyzed, she had just recovered from whoop- 
ing cough, which returned to plague us during this attack 
of typhoid fever, in spite of which she made a good re- 
covery. Her temperature, as you will see, touched normal 
on the tenth day of treatment, but went up slightly again 
on the eleventh day. On the thirteenth day the tempera- 
ture and pulse were normal and the patient was discharged, 
and ten days later was in more robust health than before 
her illness. 

Case No. 111. Sarah J., aged thirteen years. (Cousin 
of Case 105, Annie W.) When I first saw this case her 
temperature was 103°, pulse 130. The next evening it was 
103.8°, with a pulse of 136. I gave my usual prognosis, 
ten or twelve days of illness, no danger. Her temperature 
touched normal on the tenth day of treatment. This case 
was an exception to the almost invariable rule commented 
on by so many observers, that after this so-called antiseptic 
treatment of typhoid fever, almost as soon as the tempera- 
ture touches normal the patient is in better health than 



TYPHOID FEVER IN CHILDREN. 



141 



before the illness. This patient had had some stomach 
trouble before her illness, and although she recovered 
quickly from the fever and her appetite was better than 
usual for a week or two, she has since been to my office 
several times for treatment of her old trouble. 



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CASE NO. 111. 

Case No. 112. Florence J., aged eleven years. (Sisterof 
Case 111.) On February 27, the temperature of this patient 
was 102. 5 C , pulse 130. Three days later it was 103°, 
from which time it declined to normal on the thirteenth day 
of treatment, the patient being in good condition and 
having an excellent appetite. 

Case No. 113. Blanche J., aged five years. (Sister of 
Case 112.) This patient had a temperature of L01.5 oil 
March 2, with a pulse of 128. On the third day of treat- 
ment it was 104° from which point it declined to normal 
on the eleventh day. 



142 



TYPHOID FEVER IN CHILDREN. 



I am not infrequently called to see young children, 
especially in consultation, in the late stages of typhoid fever, 
when no suspicion of the character of the disease had been 
aroused, but in which the symptoms are so distinctive that 
no trouble should have been experienced in making an 
accurate diagnosis. One case of this sort which had been, 
however, under the care of an irregular practitioner, was 



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CASE NO. 112. 

Case No. 98. Margaret O., aged two years. I found the 
child lying in a cradle, in the corner of the kitchen, between 
the wall and the cooking range. She was moaning pitifully 
and sometimes screaming violently; her head was retracted 
and turning rapidly from side to side. A diagnosis of brain 
fever had been made. The temperature was 106° ; 
the bowels very tympanitic and the stools very frequent. 
Taking the necessary steps in the order of their importance, 
I first dropped a little powder (to be described hereafter) on 
the child's tongue ; I then ordered the cradle to be moved 



TYPHOID FEVER IN CHILDREN. 



U3 



as far as possible from the fire, and had the child sponged 
and ordered that the powder be given every fifteen minutes. 
Later in the night I visited the child but found little change 
in its condition. The next day I visited her three times and 
that evening the temperature fell to 105°. The following 
day the symptoms began to improve rapidly, and she made 
a quick recovery, being well in ten days. 



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CASE NO. 113. 

While visiting this child on the second day, I saw a 
younger child sitting in a suspicious position and when it 
moved a bloody stool remained. Glancingaround the lloor I 
saw two or three others, which though small were quite appar- 
ent I asked the mother to explain and her answer was brief 
andtothepoint : " I declare to goodness he's been doing 
that all day ! " Upon examination I found the child with a 
very rapid pulse and high temperature. The recovery of this 
child was somewhat tedious, owing to the advanced stage 
of the disease when I was able to begin treatment. 



144 



TYPHOID FEVER IN CHILDREN. 



One of the most prominent physicians in Chicago, (a 
gentleman who was long at the head of Cook County 
Hospital, and was for many years one of the most highly 
esteemed professors in the foremost medical college in that 



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CASE HELEN McC. 



city so noted for its clever and accomplished preceptors, and 
whose name is cut in the corner stone of the college, as one 
of its founders) has done me the honor to write me several 



TYPHOID FEVER IN CHILDREN. U5 

letters of inquiry (he is altogether the best questioner with 
whom I have ever corresponded) in regard to my method 
of treating typhoid fever. He has favored me with the 
reports of several cases treated since our correspondence 
began. 

Case marked— "Dr. Mc Williams No— Helen McC, 
aged six years and three months. She was taken sick, as 
you will observe, while away from home at a summer resort. 
A diagnosis of typhoid fever was made by a local physician, 
and on the tenth day she was sent home to be under the care of 
the family physician, Dr. McWilliams. Her temperature was 
106° the first day that the Doctor saw her and on 
the tenth day she was sitting up, dressed, enjoying 'Judge,' 
'Puck/ etc." 

Dr. Cunningham, of Youngstown, reports the following : 

Case marked " Dr. Cunningham No. — Ella G., aged 
seven months. She was under the care of three different 
physicians, before I saw her in consultation. 

The first physician (according to the statements of the fam- 
ily) made a diagnosis of whooping cough; the second physician 
said it was meningitis." The child growing worse, Dr. 
Cunningham was called and made a diagnosis of typhoid 
fever. When the temperature went to 105° he called 
me in consultation. The chart indicates the rapidity 
with which the child recovered. The correctness of the 
diagnosis was corroborated a few weeks later, when the 
mother of the child (see chart marked Dr. Cunningham 
No. — Mrs. G.) had an attack of typhoid fever, from which 
she recovered; and the uncle (see chart marked Dr. 
Cunningham No. — James K.) died of shock, resulting from 
an intussusception, occurring after he was almost well from 
an attack of typhoid fever. 

Dr. C. N. Udell, of Iowa, kindly sent me a report of 



H6 



TYPHOID FEVER IN CHILDREN. 



twelve cases of typhoid fever, and one of cholera infantum 
treated by my method, with excellent results from which I 
extract the following record of cases of typhoid fever in 
children : 



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CASE ELLA G. 



^ Case 8. S. B., male, aged nine years. Was taken with 
chills, fever, headache, vomiting and some abdominal pains. 
Treated by the family for ague. I was called after the boy 



TYPHOID FEVER IJV CHILDREN. \\~ 

had been sick eight days. Found the temperature 104.6° 
skin dry, tongue very dry and red, dirty gray fur 
in center ; very nervous ; hyperesthesia, delirium, a papular 
rash; secretions locked. Gave to this boy Nos. 1 and 2 for 
two days ; repeated it at short intervals. Then No. 1 for 
three days ; No. 3 for four days. Discharged patient on 
ninth day. In this case, as in all others, I insisted on 
frequent sponging of the body, frequent change of linen, 
good ventilation of the sick room, same food given at regular 
intervals, etc. 

"Case No. 10. N. S., male, aged eight years. Had an 
intermittent fever. Prescribed c. cath. pills and quinine without 
seeing patient. Continued sick and weak ; no improvement. 
Visited the boy and found temperature 104°, skin dry, 
suppression of urine ; very weak, headache, and general 
aching, some delirium, very foul breath, heavy gray fur on 
tongue with edges red, sondes on teeth, a good deal of tym- 
panitis, some eruption, and sudamina. Diagnosis: septic 
fever, or paludal typhoid." 

" Gave R. No. 1 and No. 2. After three days gave R. 
No. 3. On the seventh day gave Nos. 1 and 2 again. 
Then No. 3 for about one week at longer intervals. Patient 
discharged well." 

"Case No. 11. D. H., male, aged two years. Was sick 
with diarrhoea, high fever, very restless, abdomen puffed, 
vomiting, and furred tongue with foul breath. Gave baptisia 
tinct. R. No. 3 in minute doses. Recovered in five days." 

Case No. 12. E. P., aged eighteen months. Hygienic 
surroundings very bad. Child had cholera infantum with 
very offensive stools. Gave R. No. 1 in very minute doses 
every half hour. Had the child kept as clean as possible, 
and that was not very clean. The child recovered speedily 
in spite of bad nursing. 

These cases illustrate the admirable results which may 
be invariably obtained and even confidently predicted, when 
proper treatment has been instituted at a sufficiently early 
stage of the disease and intelligently and energetically pros- 



148 TYPHOID FEVER IN CHILDREN. 

ecuted ; and they, by contrast, serve as a warning against 
the danger of mistaking the nature of the most common, the 
most dangerous and by far the most frequently overlooked 
cases of typhoid fever in children, viz., those cases in which 
the nervous manifestations are in the ascendant ; those cases 
which are diagnosticated as brain fever, meningitis, or cerebro- 
spinal meningitis. These are the cases in which an inac- 
curate diagnosis is most liable to occur and which is so often 
followed by such disastrous results. 

As long as the best treatment for typhoid fever, known 
to the medical profession, aimed only to ameliorate the most 
perilous symptoms as they presented themselves, it did not, 
perhaps, greatly signify when an exact diagnosis was made, 
or indeed, whether or not it was ever correctly made 
but we are approaching a more enlightened era. In reality, 
the day has even now dawned upon us in which the treat- 
ment to a fatal end, of a case of typhoid fever with a tem- 
perature of 105°, as a case of indigestion, with inefficient 
antiseptic medicine, starch and laudanum injections, and 
cooling baths, is no longer admissible. 

The physician who respects the Hippocratic oath and 
does the utmost in his power for his patient, must acquire 
skill in differentiating betwixt those diseases which can and 
which cannot be benefited by the abortive treatment of 
typhoid fever. 

Without entering into the field of speculative controversy, 
it may be generally stated, that any of the so-called microbic 
diseases, such, for instance, as diphtheria, malarial fever, 
measles, scarlatina, cholera infantum, etc., would lose much 
of their fatality if treated on the same general principles 
which I have so often advanced for the treatment of typhoid 
fever.* 



*The treatment of typhoid fever in children is transferred to its proper place 
after treatment. 



REPORTS ON TYPHOID FEVER (Continued). 

EIGHTH PAPER. 



Mr. President, and Gentlemen of the Society : 

A few days since, I over heard a physician say : "there 
is no physician in the world so learned, and possessed of 
such perfect integrity, as to have been able to convince me, 
by any statement, that the uniform results I have seen Dr. 
Woodbridge secure in the treatment of typhoid fever were 
possible." When asked by his interlocutor what he 
regarded as the strongest evidence of the truth of the dec- 
laration that "typhoid fever can be aborted," he answered; 
"seeing it done." "After that, the charts and reports of 
cases of other physicians who have treated typhoid fever by 
Dr. Woodbridge's method, and have thus succeeded in 
saving the life of every patient and greatly shortening the 
duration of the disease." His remarks prompted me to amend 
the report which I had prepared, of cases of typhoid fever 
which I had treated during the past year, by embodying in 
it some accounts of the failures and successes of other 
physicians, who have essayed the abortive treatment of the 
disease, relying on the directions which I had given in 
papers (written only to prove that the disease could be 
aborted), on hastily written letters, on instructions given 
orally, or on bedside consultations. Many of them have 
shown their enthusiasm over the results of their trials and 



*Read before the Ohio State Medical Society, Columbus, Ohio, Seventeenth 
of May, 1895. 



149 



150 TYPHOID FEVER. 

tests of this method of treatment, by sending me clinical 
charts of the cases ; and gratefully acknowledging their 
indebtedness to me for their marvelous success. 

A most laudable example of true courage and heroism 
to thus report results (the very possibility of which had 
been so strenuously denied), which precedent it is devoutly 
to be hoped may be largely followed. 

As the object of this paper is to place the Ohio State 
Medical Society in a position to reach a just conclusion of 
the veracity of the affirmation, "that typhoid fever can be 
aborted," I shall draw from all these sources. Many of the 
original clinical charts (copies of which I hand you) and the 
letters from which excerpta are made, are here for your 
inspection. 

Those of you who were present at the last meeting of 
this Society, when I read my paper on "typhoid fever," 
will remember that a member arose in his place, and said : 
"being from Dr. Woodbridge's town and Society, I wish to 
say that we have had several "fights" on this subject and 
we have been watching his cases for several years, to see if 
he could make his pledges good, but so far we have been 
unable to discover that he has made any failures, or had a 
death from typhoid fever. And we intend to continue to 
watch him in the future, and if he have a death we will 
report it." The fact that no such publication has been made, 
may be accepted as conclusive testimony that for thirteen 
years I have had no death from the disease and have aborted 
every case of typhoid fever which has come under my care 
at a reasonably early stage of the disease. 

During the past year I have treated alone or in con- 
sultation fifty-eight cases of typhoid fever. During the same 
period, there have been treated by 117 other physicians, 
acting under my advice ; by consultation at the bedside ; in 



TYPHOID FEVER. 151 

conversations in which I have given very complete and 
precise counsels in regard to the guidance of the patient 
throughout the illness, more than eight hundred cases. 

I have seen in consultation, during the past twelve 
months, two fatal cases.* 

Case No. 1. Mr. H. C. O., of Sewickly, Penn. 

This patient had been sick and feeling miserably, and 
under the supposition that he had la grippe, had been 
taking quinine for several days. Yielding to the inevitable, 
he finally went to bed and sent for a physician, who found 
that he had pneumonia. Later he had an alarming haemor- 
rhage of the lungs. No pathognomonic symptoms of 
typhoid fever were observed until the night of the 1st of 
December, during which he had numerous profuse intes- 
tinal haemorrhages. I was called the next day and found 
him in a condition bordering on collapse, bleeding from 
both the lungs and bowels, and he died before the haemor- 
rhages could be arrested, 

The only other fatal case which I have seen in con- 
sultation occurred in the practice of Dr. M. V. Cunning- 
ham, whose experience in the Cook County, 111., Hospital 
and at the Emergency Hospital, during the World's Colum- 
bian Exposition, had served to render him an unusually 
accurate diagnostician and taught him to appreciate the 
value of antiseptic medication. Conservative to a degree, 
educated to believe that there was no power in medicine to 
abort typhoid fever, he had watched my cases with the eye 
of an unfriendly critic, until forced by the logic of my re- 
peated successes, he called me in consultation several times. 
and consequently was able to produce such brilliant results 
in a number of instances that I had the most implicit con- 



* Since this paper was written a third case, which I saw only once on the 
twenty-ninth day of the disease, died. 



152 



TYPHOID FEVER. 



fidence in his ability to treat typhoid fever in a perfectly 
scientific manner. 



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CASE JAMES K. No. 3. 



Case No. 3. James K., aged twenty-four years. (See 
chart marked Dr. Cunningham No. 3.) 

This patient was very sick on the 30th of March. On 
the 1st of April he sent for a physician, who (according to 
the statements of the family) made a diagnosis of la grippe, 





Plate 1. 

One section of ileum from near the lleo-caecal valve and ' from 

about three feet nearer the stomach of Dr. Cunningham's 1 :; Jamei 

K.— of aborted typhoid fever, showing healthy granulating nlcers of Payer's 

glands. 

See chart of this case on opposite page. 



TYPHOID FEVER. 153 

and called again the next day. The patient grow inn- 
worse, Dr. Cunningham, who a few weeks earlier had 
treated a niece of the patient through a very severe attack 
of typhoid fever by the method I had advised with unusual 
success (see chart marked Dr. Cunningham No. 4, Ella 
G.), was called on April 6, and on April 7, he called me in 
consultation. I found the patient had been so sick nine 
days before I saw him as to lead to the obvious conclusion 
that he had been sick even longer ; a conclusion fully 
justified by his condition, his temperature having been the 
previous day 105°, his bowels excessively tender and tym- 
panitic, nervous symptoms exceedingly bad, his tongue 
tremulous, very dry and brown. He had persistent hic- 
cough, and was delirious. 

The next morning Dr. Cunningham came to my office 
to say that his patient was so wildly delirious that his father, 
who was taking care of him, was unable to give him medi- 
cine and could with difficulty keep him in bed, and conse- 
quently wished to send him to the hospital, a desire which 
met my heartiest concurrence. This unfortunately 'was 
abandoned on account of expense. 

I did not hear from the patient again until April 1". 
when Dr. Cunningham invited me to see him, remarking 
in a pleased way, "I would like you to visit him once more 
before he is well, and you must hurry or you will be too 
late, for his temperature was 101° this morning, and at the 
rate it is dropping it will be normal in a day or two.' 
Visiting him about 10 A. M., we found his temperature 
100.6°, his tongue moist and less coated, his head dear, his 
abdomen quite flat and entirely free; from tenderness ; tym 
panitis very slight; nervous symptoms greatly improved, 
and sleeping naturally. He had taken no antipyretics or 
stimulants. His condition having improved so rapidly 



154 TYPHOID FEVER. 

since my last visit, I told the doctor that I believed his 
patient would be well in less than ten days, and according 
to the reports he continued to improve until the following 
evening, when his symptoms were all better and his tem- 
perature was 99.6°. Up to this time the disease had run 
the usual course expected under antiseptic treatment, and 
save that it had been instituted too late to prevent necrosis 
and ulceration of Peyer's glands, which must needs have 
time to heal by granulation, the patient was nearly well. 

Consequently I was greatly surprised when Dr. Cun- 
ningham telephoned me the next day, that the patient had 
had two convulsions during the early morning, and was very 
restless, delirious, and seemed to be suffering great pain, 
apparently abdominal, as indicated by the manner in which 
he rubbed and tugged at this region. 

Examination revealed a doughy mass, filling up the 
abdominal cavity, most solid on the right side. He continued 
to have convulsions; his mouth and tongue became dry and 
parched ; his temperature became subnormal ; he grew more 
restless ; his delirium became more profound ; and he died 
of shock two days after the accident. The autopsy revealed 
an intussusception, the obvious cause of death by shock to the 
nervous system, already exhausted by the long and ex- 
ceedingly severe delirium, and under great strain on account 
of the septic condition, due to the enormous pyogenic surface ; 
the whole of the small intestines being inflamed, and all of 
the agminated glands of Peyer, in the more than six feet of 
intestine examined, ulcerated. The stomach and intestine 
above the intussusception were full and distended, almost 
beyond endurance ; below it, empty and collapsed. 

This case presents the strongest possible confirmation of 
the correctness of my diagnosis, because there is not, amongst 
all of these cases that I have reported as typhoid fever, a 




Plate 2. 

Section of ileum from fatal case of typhoid fever (not treated by the Wood- 
bridge method), showing unhealthy ulcers of Peyer's glands 



TYPHOID FEVER. 155 

single case which offers fewer pathognomonic symptoms of 
the disease, than this one. It positively confirms my dec- 
laration that "typhoid fever can be aborted," for severe as 
it was, and despite the fact that treatment was so long- 
deferred that necrosis of Peyer's glands was unavoidable I 
it yet pursued the ordinary course toward recovery, and 
before the unfortunate accident which caused his death, 
occurred, he was practically cured. 

It presents the most convincing and irrefutable evidence 
of the validity of my assumptions as a whole, and it seems 
to me, that it should overwhelm with shame and confusion, 
the arrogant, and impudent critics, who forgetful of my 
nineteen years of clinical experience, with a method of treat- 
ment to which they have not given the slightest attention ; 
presume to say that because the thermic line on the clinical 
chart does not present the so-called typical typhoid fever 
curve, ipso facto, it ceases to be a typhoid fever chart. 

If any one of the gentlemen are present, who in former 
years have criticised my charts (and in doing so have 
positively asserted that a chart showing a step-like decline 
in the temperature, which touches normal in eight or ten 
days, could not be one of a case of typhoid fever), will 
scrutinize well the chart marked Dr. Cunningham's Case 
No. 3, James K., and examine also that book of charts, in 
it he will find that there are not three charts which depart 
further from the so-called typical "typhoid fever curve," than 
the delineation of the thermal line on the chart of this man. 
whose small intestine presented the most extensive series ot 
ulcerated Peyer's glands that I have ever seen. 

Had the physician, who was called to attend this man on 
the first of April, made a correct diagnosis, or failing to do 
so had he called in consultation a physician who, if unable 
to make a positive diagnosis, would at least have given the 



156 TYPHOID FEVER. 

patient the benefit of the doubt, and immediately instituted 
proper antiseptic treatment, the misfortune of an intussus- 
ception may still have befallen the patient, and he may have 
died ; but he would have been spared those days of burning 
and torturing fever ; those sleepless turbulent nights of wild 
delirium; the necrosis of Peyer's glands and their conse- 
quent dangers. 

I have known all these years, that these were the 
clinical charts of cases of true typhoid fever; known that 
in some of the patients the disease had progressed so far 
that necrosis and even ulceration of Peyer's glands, had 
already supervened ; and I have also been well aware that 
there were amongst them the records of the illness of 
patients, who, but for the treatment I had advised would 
have been sleeping beneath the sod. 

In nearly every medical society before which I have 
presented dissertations on typhoid fever, certain members 
have wisely delivered themselves of one or more of the 
following sage citations, either literally or with a very slight 
rearrangement of words ; as for instance. "We all know 
that typhoid fever is a specific infection that must run its 
course of four, five, six, or ten weeks or longer." Or it 
may be that one will sapiently remark; "if there is one 
fact in medicine that is well established, it is that the course 
of the disease in typhoid fever cannot be shortened by a 
single day." And these erudite persons seem to deem these 
parrot-like assertions as incontrovertible testimony, amply 
sufficient to confute totally and instantaneously, the whole 
of the accumulated evidence of my clinical experience ; and 
indeed even quite sufficient to disprove the statements of 
all the proficient physicians who have corroborated my 
diagnoses and results. But it should be remembered, that 
unwarrantable assumption is not valid reasoning and the 



TYPHOID FE VER. \ 5 7 

plausible arguments that have been adduced in confutation 
of my claims are not more convincing than have been 
opposed to every step in the progress of medicine. 

In the Cleveland Medical Society, where without 
malice toward any member of the medical profession of that 
city or locality ; but for the two-fold purpose of emphasiz- 
ing my confidence in the potency of antiseptic medicine ; 
and also of letting the profession abroad comprehend 
and realize that I had attained the unattainable, that I 
had in defiance of all known laws of pathology, 
" achieved a victory " over diseases of a microbic origin, 
which, when accepted by the medical profession, would 
add perceptibly to the average duration of human life! 
by greatly reducing the mortality from this class of 
diseases. I told what I had accomplished, described my 
method of procedure, and stated in strong language the 
responsibility which I believed devolved upon those 
members of the profession, who knowing or having the 
means of learning how to save the lives of all cases ot 
typhoid fever, and who failed to give their patients the 
benefit of the knowledge ; thus nettling the members of 
this, as well as of my own local society, to such an ex- 
tent that had my house been made of glass it would 
soon have been about my ears, for my expressions were 
harshly criticised, and in the heat of debate main broad 
and preposterous arguments were advanced. 

The ubiquitous professor, already in possession of 
all of this world's knowledge that is worthy of Ins atten- 
tion, was ridiculously conspicuous, in a way that would 
have been laughable, had not the subject been so seri- 
ous, and exposed his ignorance not only of antiseptic 
medicine, but of the true character and pathology oi 
typhoid fever. Thus one savant added superciliously 



158 TYPHOID FEVER. 

and blusteringly to his previous remarks : " He claims 
that the temperature has gone to normal in four or five 
days after intestinal haemorrhage. Absurd; what could 
he do for the ulceration of the bowels?" As if the 
ulceration of Peyer's glands were the cause of the ele- 
vation of temperature. Absurd; and as a climax and 
final adjustment of the subject said, sententiously: "Talk 
of aborting typhoid fever; impossible." To me and to 
those who have with ease, confidence and tranquility 
aborted the disease, these infelicitous comments are 
"absurd" indeed. 

A latter day Sydenham, gifted with peculiar perspicu- 
city, selected three charts as looking to him very much 
like the records of the temperature in cases of malarial 
fever. The fact of the matter is, that his extraordinary 
clear sightedness availed him nothing, for he had, un- 
luckily for himself, chosen the charts of three cases of 
typhoid fever, which occurred during two epidemics. 

The patients had been examined and the diagnoses 
verified, by no less than six different physicians, at the 
bedside; and no doubt was expressed at the time as to the 
character of the disease. It is hardly conceivable how so 
grievous a mishap could have befallen the critic, for the 
thermic lines on the charts did not delineate the rise and fall 
of the temperature of malarial fever, a blunder inexcusable 
even in the most inexperienced medical man. The argu- 
ments thus adduced by notable professors, whose repu- 
tation for scholarship has heretofore been undisputed, 
have been puerile indeed, unworthy alike of the speak- 
er, his auditors, and the topic under discussion. It 
is hard to understand how a philosopher, so penetrating, 
so profound, could be so willfully blind, as not to have 
observed that at least fifty of these were the clinical charts 



^i* 



Plate 3, 
Showing intussusception which caused the death of Dr. Cunningham's ca 
3— James K. 



TYPHOID FEVER. 159 

of typhoid fever patients^ach one of whom had been ex- 
amined by from two to six different physicians, the diag- 
noses and results of treatment attested to, and all of these 
facts written on the face of the original charts which were 
signed by physicians whose integrity and expertness in 
diagnosis cannot be questioned. 

But when these charts were criticised and when the 
fact that the temperature touched normal in seven or 
eight days, was said to be proof that these patients did 
not have typhoid fever, I knew that, if the opportunity 
should ever present itself I would be able to demonstrate 
on the cadaver the truth of my statements. I little ex- 
pected, however, that I would live to see a case of 
aborted typhoid fever in the dead house. 

But here I present to you a temperature chart, kept 
at the bedside of the patient by the attending physician, 
Dr. M. V. Cunningham (Case, No. 3 — see page 152), in 
which the temperature touched normal on the seventh 
day of treatment — the thirteenth day of the disease. 
And here I present to you both dried and moist speci- 
mens of the intestine of the same patient, showing the 
characteristic and extensive ulceration of Peyer's glands. 
Here is the intussusception which caused the death. 
Please open the bottles and investigate to your entire 
satisfaction. The bedside history and the pathological 
specimens prove conclusively that one case of typhoid 
fever was aborted. " Ab uno disce omnes." Thus 
this obscure colored man, dying, has rendered a greater 
service to the world than can her most distinguished 
citizen, living. 

It is interesting to note that every adverse criticism 
of my theories, my management of disease or my con- 
clusions, have come from those having no practical and 



160 TYPHOID FEVER. 

I fancy, very little theoretical knowledge of the subject ; 
while those who have tested my methods have favored 
me with more valuable reports and kindly expressions 
of approval of the same than I have been able to tran- 
scribe or properly answer. 

I append a few of them here; I presented others in 
my papers read before the Sections on Pediatrics and 
Practice, A. M. A., last week. 

Dr. John McCurdy, one of the most distinguished 
physicians in the State of Ohio, many times President of 
his County Medical Society, ex-President of the Ohio 
State Medical Society, during the war was Regimental, 
Brigade and Division Surgeon, Assistant Medical Direc- 
tor and Acting Medical Inspector of the 14th Army 
Corps, has had 320 cases of typhoid fever under his care 
at one time ; a firm believer in the idea that any limita- 
tion of the course of the disease in typhoid fever was 
impossible. In the County Medical Society, in 1880, he 
spoke eloquently against the acceptance of my theories, 
and in 1893, in the same society in which he had spoken 
thirteen years before, said : " Dr. Woodbridge has made 
the greatest discovery that has been made in medicine 
for a hundred years. I have treated typhoid fever by 
his method for several years and have aborted a large 
number of the sixty-five or seventy cases treated since 
1890, although I have not been able to abort every case, 
and have had two or three deaths, these occurred, how- 
ever, in cases that came under my care at the end of the 
second week of the disease or later. I know that this 
treatment has power to destroy the specific poison of 
typhoid fever, and if begun early will abort the disease. 
It is the best treatment I have ever seen advised. " At a 
public banquet given to the Chamber of Commerce, at 



TYPHOID FE VER. \k\\ 

which there were probably 300 guests present, Dr. Mc- 
Curdy, responding to the toast, " The Medical Profes- 
sion," said: " We claim that one of our number here is 
the discoverer of a treatment for that universal and 
justly dreaded disease, typhoid fever, which, as a rational 
and scientific plan of waging battle with that life de- 
stroyer, is far in advance of any treatment yet practiced. 
This treatment has stood the crucial test for years in 
hundreds of cases, and the theory is fully sustained by 
the long list of victories achieved." 

Dr. C. R. Justice, the very able Health Officer ot 
Poland, Ohio, and ex-member of the Pension Board, 
with whom I have had seventeen bedside consultations 
over cases of typhoid fever during the past year, had 
for years condemned my theories and denounced im- 
position as "absolutely untenable," until 1 had learned 
to regard him as a devotee at the shrine of the "ex- 
pectant method; "who would go onto the end of his pro- 
fessional career, treating the disease symptomatic rally ; 
accepting the long weeks of sickness of his patients as 
something entirely beyond his control, and the deaths as 
visitations of Providence, for which he was in no way 
responsible. I was greatly surprised, therefore, to learn 
that he had been investigating the subject for month-. 

That he has continued his investigations to good 
purpose, is proven by the success he has secured in 
treating some very severe cases of typhoid fever I a few 
of the charts of which are submitted for your inspection . 
and by the fact that I was able to write to one of his 
brother practitioners, advising him to call Dr. Justice in 
consultation, as he had treated so many eases by my 
method that I felt perfectly safe in saying to the friends 
of his patients, that if they called him early enough tl 



162 



TYPHOID FEVER. 



need never fear that he would have a death from typhoid 

fever, or that any of his patients would be severely sick. 

Your attention is especially invited to the clinical 




chart of case No. — , Lorenzo C, who had been under 
the care of two other physicians at a neighboring town. 
He had been sent home with the statement that he had a 
terribly severe attack of typhoid fever, and would neces- 
sarily be sick along time. He arrived wildly delirious, 
with a temperature of 106°, and all other symptoms of 
the disease characteristic. His temperature touched 
normal on the eleventh day, and in a few days he was 
out driving, feeling perfectly well. 

Dr. Justice has treated during the year, by my 
method, twenty-three cases, without a death ; although 



TYPHOID FEVER. 163 

some of them have been complicated by grave pre-exist- 
ing or concurrent affections, and some of them came 
under his care at late stages of the disease. In speaking 
of the treatment Dr. Justice said : " Looking back over 
the past I can see where I could have saved many lives, 
had I understood thi c method of managing typhoid fever 
as I do now ; and I think I would be committing a crime, 
were I to treat a case of the disease in any other way 
than that advised by Dr. Woodbridge." 

Dr. J. A. Dickson, of Youngstown, O., a gentleman 
of the highest integrity, a physician whose reputation 
as a general practitioner, is happily not marred by his 
success as a laparotomist, sends me the following report: 

"Youngstown, O., April 29, 1895. 

" I have treated several cases of typhoid fever with Dr. 
Woodbridge's treatment, and find that it will invariably cut the 
fever short, if commenced early enough in the disease, the illness 
lasting often but a few days, the temperature soon dropping to 
normal and remaining there. I have also tried the mixed treat- 
ment, that is, using the tablets as directed, and also perhaps, some 
turpentine emulsion, quinine, etc., but find that it pays much 
better to « hew to the line.' I have been recently treating a case" 
of typhoid fever, which came to me from another physician, who 
was ill. It had not been treated by Dr. Woodbridge's method, 
and when I first saw the case I found the temperature 104°, the 
pulse 100. I immediately commenced witli the tablets, giving 
one every fifteen minutes for the first day, one every hall hour 
during the second day, and one every hour during the third day, 
etc. Upon the second day the temperature came down to 101.8°. 
Upon the third day it was 101.4°. Fourth day, 101.4°. Fifth 
day, 101.2°. Sixth day, 98. G°. After this the temperature re- 
mained normal for four days, when the patient came down with 
pneumonia, with the characteristic rales, egopheny hepatization 
and expectoration ; from which he is now recovering. The tem- 
perature upon the onset of the pneumonic trouble went up from 
normal to 101.8° the first day, and gradually to 108°, but the 



164 



TYPHOID FEVER. 



tongue was moist and there were no symptoms of typhoid fever. 
"If I were stricken with typhoid fever, or one of my family 
were taken down with the dread disease, I think that I would feel 
like sending for Dr. Woodbridge from the Atlantic Coast to the 
Golden Gate. J. A. Dickson." 

There must be royal blood coursing through the 
veins of Dr. Reed, of Massillon, Ohio, for of such mate- 
rial as he is made, made they the kings and rulers of the 
earth in olden times. In one of the darkest hours in my 
existence he wrote me as follows : 



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"Massillon, Ohio, Nov. 14, 1894. 
J. E. Woodbridge, M. D. 

Dear Doctor : — I wish to add a word of encouragement to 
you against the many denunciations of your treatment of typhoid 
fever. I wrote for your formula some time ago, and you referred 
me to the American Medical Journal, from which was obtained the 
required knowledge. My father, Dr. T. J. Reed, has also used it, 
and we have met with very good success, and can only offer words 
of praise in its favor. 

We have been giving about 30 grains of quinine per day, 



TYPHOID FEVER. 



165 



(this being a great malarial district) for four days, and if at the 
end of that time we found the temperature high, and the symptoms 
the same or aggravated, we put them on the treatment prepared 
under your formula, and although we have not aborted the disease 
in every case inside of ten days, we have, with the exception of 
two cases, inside of fourteen days, and seldom see them after the 
sixteenth day. I have kept diligently the charts of the cases I 
have had, and have taken pleasure in showing them to the other 
physicians, who laughed at my daring to use the treatment. They 
take a different view of it now though. Had I but known a few 
hours earlier of your intention to speak in Cleveland, I should 
have gone up, and let my voice help to defend you, or if not allowed 
that, at least it may have been some satisfaction to you to have 
seen the few charts (ten in all) we have been able to prepare. 




Hoping that you may meet with greater encouragement at 
the hands of the profession, and that 1 may be able to meet yon 
personally at some future time, I remain 

Yours truly, T. F. Reed." 



166 



TYPHOID FEVER. 



A few days later Dr. Reed* kindly sent the charts to 
which his letter refers, to me with the accompanying 
letter : 

" I send you by this mail, a few of my charts that were unmis- 
takably typhoid fever cases, and some of them were the last cases 
of from two to four in the family, who had similar attacks, but of 
which I regret to say no records were kept. We have had, in all, 
about twenty-five cases, and these charts are examples of them 
all. We are well pleased with the results we have had, and can 
positively say that it is due to the form of treatment. I hope the 
charts will be of some use to you, and anything that I have is at 
your disposal. I should like to have the charts returned, as I 
have no duplicates of them, and want to keep them for future use. 
The temperatures marked were taken at the height of the disease." 

Dr. E. J. March, of Canton, Ohio, sends me the fol- 
lowing letter with the charts, which are marked" Dr. 
Marsh, Harry W. and Sadie J." : 




*The denunciations to which Dr. Reed refers are those of physicians who de- 
nounce the abortive treatment of tvphoid fever, without trial or investigation as 
they would disparage anything, which did not chance to fall within their intel- 
lectual horizon. 



TYPHOID FEVER. 167 

"Canton, Ohio, April 26, 1895. 

DR. J. E. WOODBRIDGE, YOUNGSTOWN, OHIO. 

Dear Doctor: — An apology is due you for my long delay in giving 
the reports of some of the cases of typhoid fever which I have 
treated with the medicine you furnished so kindly. I have 
simply postponed it from time to time till this P. M. I saw a 
report of some of your cases in P. D. & Co.'s therapeutic notes. 

Enclosed find the detailed treatment and temperature charts 
of two cases. The first of Mr. W. was to my mind a typical 
case. The second, Miss J., a trained nurse came from a family, 
all of whom had typical and severe attacks, at which place she 
contracted the disease. She came back to Canton and asked 
me to give her ' Woodbridge treatment', as she had nursed my 
first case, and was much taken with the results obtained in it. 
By the way, she had had large experience in New York hos- 
pitals in nursing typhoid. You will see the result as per charts 
enclosed, I had two other cases as well marked and typical 
as these two, but being in nonprofessional nurses' hands, no 
notes or charts were kept. But they were both convalescent in 
ten days' time. The one, a woman about thirty years old, had 
come from the bedside of her brother, who died from the disease, 
and she started in with a severe attack. I am sorry I did not keep 
such a record as I could, myself, so as to add water to your wheel. 
I have a friend here who has tried the plan of treatment, some- 
what modified, and says that the objection he has to it is that, 
whereas he formerly made from $20 to #40 out of each case of 
typhoid, this cuts his bills down to less than $10 in each case. 

Doctor, I feel sure that you are on the right track, and if we 
should have a run of fever in our hospital wards this fall, I will fur- 
nish you with some more charts and results. Thanking yon again 
for your courtesy, Yours very truly E. J. MARCH." 

I will now present from my own practice a few cases 
which ran a course similar to that of Dr. Cunningham's 
Case No. 3, with the exception of the unfortunate acci- 
dent of the intussusception. The cases represent not 
only most careful and positive diagnoses from the clin- 
ician's standpoint, as they were generally verified by one 



168 



TYPHOID FEVER. 



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TYPHOID FEVER. 



169 



or more physicians ; but every precaution has been taken 
to reduce errors of diagnosis to a minimum, by calling to 
my aid every known means of excluding mistakes. The 
diazo-reaction described by Ehrlich, and the microscope 
were appealed to, and in a large number of cases where- 
malarial fever was suspected, or had been diagnosticated, 
careful search was made for Laveran's hematozoon. 

Case No. 106. Mrs. McC, aged seventy years. Was 
a feeble woman, and one of five typical cases in one house. 
When I first saw her, on February 7, 18 ( J5, her temper- 



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CASE LEN0RE S. No. 101. 

ature was 105°, pulse 140. Although she was reported 
to have been sick only frve days, she was delirious ; her 
bowels were very tender; there was considerable tym- 
panitic distention ; rose spots were abundant : her tongue 
was thickly coated, dry and brown. Her temperature, 
as you will see, had dropped to 99 , her pulse 96, on the 
13th of February, after which her temperature was not 
taken ; and in a few days she was able, to be about, and 
at the end of a week was out of doors. 



Case Xo. 101. Lenore S., aged twenty-seven y< 



170 TYPHOID FEVER. 

(daughter of Case No. 106, residing in same house). 
When I first saw her, on Jannary 14, 1895, she had a 
temperature of 103°, pulse 120, and all other symptoms 
of typhoid fever as characteristic as were those of her 
mother. A few days later, January 17, her temperature 
was 100°, her pulse 100, and the general condition so 
much improved that I have no record until the 21st, when 
the temperature had been reduced to 99.8° and the pulse 
96. I saw her the last time on the 26th, and she was out 
in one week. 

Case No. 108. Carolyn S., aged two years (daughter 
of Case No. 101). She was far from well on February 
7, when I was called to see her grandmother, and on 
February 9 had a temperature of 105.2°. She was dis- 
charged, cured on February 16, after nine days of treat- 
ment. 

Cases Nos. 107 and 109. Katie McC. and Jerry 
McC, aged respectively five years and twenty-three 
years (granddaughter and son of Case No. 106). These 
cases both showed decidedly characteristic symptoms of 
the disease, but recovered so rapidly that no records were 
kept. 

Case No. 115. John O'L., aged twenty-eight years. 
This young man was taken sick on the 1st of March 
and was treated by an irregular practitioner who called 
two other physicians in consultation after twenty-two 
days of illness, during which time (according to the 
statement of the family) a diagnosis was made of la 
grippe, malaria, pneumonia, and finally of pneumonia 
with "typhoid malaria." On the 22d of March an un- 
favorable prognosis was given and I was sent for. I 
found a typical case of typhoid fever, complicated with 
pneumonia. His temperature was 103°; pulse 118, and 
dicrotic ; condition of nervous system very bad ; he was 
sleepless and delirious; his abdomen was covered with 
rose spots ; typanitic distention enormous ; bowels very 
tender ; tongue very dry, brown and cracked ; he was 



TYPHOID FEVER. 



171 



spitting blood and had three intestinal haemorrhages. On 
the 25th of March his temperature was 104.7°. However, 
his condition improved rapidly indeed ; he was sleeping 
naturally, without hypnotics, on the second night, when 
he was no longer delirious. Within three days, his ab- 
domen flattened out ; the tympanitis disappeared ; his 
appetite returned, and he declared that he was gaining 
strength on milk diet. On the 1st of April and the fol- 
lowing day, the temperature being normal, he was dis- 



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CASE MARY O'L. No. 120. 

charged cured. Dr. M. V. Cunningham, who is much 
interested in the abortive treatment of typhoid fever, saw 
the case with me, for the purpose of watching the (Meet 
of treatment. He pronounced it wonderful. 

Case No. 120. Mary O'L. (sister of Case No. 116, 
John O'L.) I was called to see this case on the 2 
April, and was given the following history 



She had 



172 TYPHOID FEVER. 

nursed her brother through a very severe attack of the 
fever a month before. During- the latter part of his 
illness she had severe headache and general malaise. 
About two weeks before I saw her, her headache in- 
creased, her back and limbs ached, she became dull and 
apathetic, and as her mother expressed it, "could hardly 
drag one foot after the other, she, who was the most 
active and energetic of all the kith and kin." At this 
time she took the residue of the medicine I had left for 
another sister, whom I supposed was taking typhoid 
fever (from which illness she recovered at once) after 
which she felt quite well for several days. Six days be- 
fore my first visit the headache returned, the back and 
limbs began to ache, and all the characteristic symptoms 
of typhoid fever presented themselves ; her pulse was 
120, her temperature 104.9°; her tongue heavily 
coated ; spleen enlarged ; her bowels very tender and 
tympanitic. I left her in the care of Dr. M. V. Cun- 
ningham, on the ninth day of treatment, when I started 
to attend the meeting of the A. M. A. at Baltimore. 
During my absence she had a very severe intestinal 
haemorrhage, but made a good recovery. While Dr. 
Cunningham was making his daily visits, a married 
sister was taken sick with the fever and proper treat- 
ment was instituted early, so that the temperature never 
rose above 103.5°, and on the seventh day, when she was 
doing very well, her husband came home drunk and 
brought with him an irregular practitioner, who very 
promptly decided that she had no fever. It was very 
fortunate for his reputation that he was called in after 
Dr. Cunningham had aborted the disease. 

Case No. 116. E. S., aged forty years (husband of 
Case No. 84.) This patient resides about four miles 
from my office and he drove that distance to see me 
about one o'clock each day. He consulted me first on 
the 1st of April, when I found his temperature was 100° 
and pulse 112. Although feeling at times miserable he 
was able to be out each day, as I had advised him, and 



TYPHOID FEVER. 



173 



on the loth his temperature was 99.4° and pulse 80, 
and his recovery was excellent. 

Case No. 114. Mrs. Michael J., aged thirty-two years. 
This was the fourth case of typhoid fever in the same house 
at once (the three other cases were reported in the paper 
which I read in the Section on Pediatrics, A. M. A., in 
Baltimore). A small son, Case No. 78, John J., and a 
little niece, Case No. 105. Annie W. having also had 
the disease some time before. The symptoms were not 
well defined and an absolutely positive diagnosis was 
not possible, but as the family used water* from a well 
which was supposed to be the source from which several 
other cases had originated, she was treated as a case of 
typhoid fever and assured that if the diagnosis were 
correct she would not be confined to her bed or be long 
sick or too sick to nurse her three children, who had the 
disease, as I had been able to treat her from the be- 
ginning of her indisposition. 



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CASE FRANK S. No 110. 

Case No. 110. Frank S. This was an ambulatory 
case, and although the symptoms seemed to indicate 
that the patient was growing worse, his temperature 
being 103° on the sixth day of treatment, he felt fairly 
well after the first two or three days. 



174 TYPHOID FEVER. 

Case No. 118. John S. This case showed premon- 
itory symptoms of typhoid fever for more than a week 
before the patient consulted me. He drove to my office 
for a few days, with all of the marked characteristics of 
the disease plainly to be seen, but finally had to go to 
bed for a week or more. The temperature ranged from 
100° to 102.8° for eight days, and he was discharged 
cured on the twelfth day. 

Case No. 117. George J., aged fourteen years. Hecame 
to my office on the 14th day of April, and called daily for 
four or five days, when his afternoon temperature was 
only 101°, but his other symptoms were sufficiently char- 
acteristic to justify a diagnosis of typhoid fever. I soon 
discovered that he was not doing well, and warned him 
of the danger of neglecting, to follow implicitly my in- 
structions. After which he improved fora few days, but 
again grew worse. Sending for his father, I learned 
that he had been left to take his medicine or not, as he 
chose ; and choosing the latter, he had been casting the 
expensive medicine which I gave him into the cuspidor. 
I refused to have anything more to do with him, unless he 
was properly nursed, when his mother gave up her situa- 
tion and gave him her care; but more than two weeks had 
now passed, and instead of being well, as he should have 
been, his symptoms were all aggravated ; his pulse 136 ; 
temperature, 103 2-5° ; the tympanitic distention of the 
abdomen was enormous, and his bowels were very ten- 
der and painful. 

Leaving him under the care of Dr. Cunningham I went 
to Baltimore, and returning on the 13th of May, the Doctor- 
requested me to see him, saying that he was unable to con- 
trol him. On several occasions he had stolen out of bed and 
secured bread and other articles of solid food and once he 
was said to have eaten a pound of candy. I ordered him to 
be handcuffed to the bed, where he still remains, but is 
nearly well. 



TYPHOID FEVER. 



175 




CASE ELLEN H. No. 104. 



176 TYPHOID FEVER. 

Case N o. 1 04, Miss Ellen H. , aged twenty years, residing 
in a neighboring town; she had been sick ten days, under the 
care of the family physician, who, being one of those gentle- 
men who do not believe in the possibility of aborting typhoid 
fever, very naturally blundered in his diagnosis, and treated 
her for la grippe, until about four days before I was 
called. At this time he corrected his diagnosis to typhoid 
fever, which caused no little excitement, as the other most 
prominent physician in the town was, and is, an enthusiastic 
advocate of the " Woodbridge method," (he says publicly 
that no patient should die of typhoid fever. ) Thus the 
friends of scientific medicine and the friends of "old fogyism," 
became partisans ; and for days that young lady's mother, in 
her anxiety to save her daughter from death or needless 
suffering, was swayed from side to side. It would be hard 
to tell which party would have won, had not the condition of 
the patient become alarming ; for, although the Doctor was 
keeping the temperature down nicely with acetanilid and 
sponge baths, and was sustaining the heart with strychnine 
and digitalis, her mother could see that all was not right, 
and she, at last, telephoned to me to come down and meet 
the attending physician in consultation. I found both physi- 
cian and friends exceedingly anxious about a "failing heart," 
a threatening danger which I assured them would disappear 
as soon as a little of the poison of the disease was neutralized. 
I discontinued all heart tonics and stimulants, and all medicine 
in fact, except the three prescriptions which I have advised 
in former papers ; and before I made my next visit, the fol- 
lowing afternoon, all the ill-omened heart symptoms had 
vanished and the pulse had resumed a healthy tone. In two 
or three days, all of the nervous symptoms, all of the tym- 
panitis, all of the abdominal tenderness were gone, never to 
return, and she was very comfortably sick, although, as you 
will see by the chart, the temperature did not touch normal 
until the eleventh day. 

In conclusion, I wish to say, that an apology is due the 
large number of physicians who have reported cases of 
typhoid fever treated and aborted by the " Woodbridge 



TYPHOID FE VER. \ 7 7 

method," which I have been unable to reproduce here or in 
my previous papers, for want of time, an unintentional 
discourtesy, since the twenty minutes which are allowed me 
in the medical societies, or the space in the "journal " 
would have been wholly inadequate to admit of even the 
briefest possible mention of all the valuable and valued 
reports in my possession. But every case reported is an 
object lesson to those who doubt the possibility of aborting 
typhoid fever, and each individual account will aid in hasten- 
ing the day when death or long or severe illness will be 
unknown. Hence the medical profession is to be con- 
gratulated that it has in its ranks, proficient and practiced 
men, whose finesse and savoir-faire enables them to learn 
the truth, and whose manliness endows them with the cour- 
age and valor to teach it. 



REPORTS ON TYPHOID FEVER.* 

(continued.) 

When I first publicly declared that " death is a wholly- 
unnecessary consequence of typhoid fever, and that 
every case in which proper treatment is instituted suf- 
ficiently early in the course of the disease can be 
aborted," I stated also that " I fully appreciated the dis- 
grace and ignominy which would await me" should I be 
found guilty of promulgating a false doctrine. 

I knew that I was speaking a language which would 
be utterly unintelligible to the greatest thinkers in the 
profession ; and also that it would have been so to me, 
but for the eclaircissement of many years' experience. As 
it took so much evidence to convince me — first, that any 
case of typhoid fever could be aborted ; then, that any 
severe case could be aborted ; and finally, that every case 
could be aborted, and death from the disease could be 
always averted, I cannot understand how, without the 
most indisputable and undeniable proof, these claims can 
be admitted by any physician, who had been taught as I 
was in my youth, to regard typhoid fever as a " specific 
infection," possessed of some occult power of resistance 
to all curative treatment, which it was hopeless, if not 
flagitious, to attempt to counteract, and a completion of 
the title of " quack" to make any pretension to having 
succeeded in so doing. 

*Read before the Section on Practice, A. M. A., Baltimore, Md. 

178 



REPORTS ON TYPHOID FEVER. L79 

I shall, therefore, endeavor in this report to present 
the strongest available evidence, not only that the 
declaration is true, but that which for want of a better 
name I have designated "Antiseptic Medicine," has a 
reserve power for good that I have not even mentioned. 
For this purpose I wish to reproduce the verdict of a few 
of the many physicians who have treated by my method 
a large number of cases of typhoid fever, and also to 
note some of the most characteristic or otherwise inter- 
esting cases which I have treated since our last meeting. 

Desiring to give every facility for the formation of a 
just estimate of the value of my statistics, I have invited 
the closest scrutiny of my cases of typhoid fever ; have 
ever held myself in readiness to demonstrate the correct- 
ness of my theories, in hospital or in private practice, at 
home or abroad ; and I have requested the publication of 
any failure on my part to do all that I have been teach- 
ing the medical profession that it ought to do. I have- 
also promised to present a report of cases before some 
great medical society each year, until a general assent 
has been given to the accuracy and truth of my theories, 
and death from typhoid fever is unkown, and long con- 
tinued, constitution destroying sickness from the disci .<• 
shall be regarded as a disgrace to the individual practi- 
tioner, and not as at present a reproach to the great 
body of the medical profession. 

During the past year, as during the preceding thirto en 
years, I have had no death from typhoid, malarial, or an\ 
continued fever, or following any pathological "condi- 
tion, which could by any possibility be mistaken for 
either of them, and I have failed in no instance, in which 
the patient has come under my care before the eighth 
day of sickness, to abort the disease. 



180 REPORTS ON TYPHOID FEVER. 

Since my return from San Francisco, last July, 1 have 
treated, alone or in consultation, fifty-eight well-marked 
cases of typhoid fever. Of these cases some occurred 
in Youngstown, or the surrounding country or towns ; 
some in Pennsylvania ; some in Northern Ohio, and 
some in other States ; and no doubt existed in any in- 
stance, in the minds of the attending or consulting physi- 
cians, as to the correctness of the diagnosis. I have, 
during the same time, aborted the disease in a large 
number of cases, of which no charts were preserved. 

During this period there have been reported to me 
as treated by other physicians, acting under my advice 
given orally, in consultation at the bedside, by letter or 
otherwise, about 800 cases of typhoid fever, with nine 
deaths from the disease. A marvelously good result 
when it is remembered that they were sailing on an un- 
known sea, with no pilot to steer the course ; that they 
had unshipped the rudders, thrown overboard the com- 
passes and were endeavoring to weather, unaided, the 
fiercest storm that could ever strike the ship — having 
learned that all recognized methods of treating typhoid 
fever are so valueless that the cleverest men deny the 
possibility of doing what 117 physicians have done, viz. : 
curing the disease. They abandoned all the procedures 
with which they were familiar and with only a brief out- 
line of my modus operandi, which must necessarily have 
proven a quite insufficient guide ; yet there were enough 
earnest and conscientious physicians, whose keen insight 
and mother wit enabled them to follow these rather in- 
complete directions to a successful issue, in so many 
typical cases of typhoid fever, as to afford me conclusive 
evidence that the disease can invariably be aborted and 
every life saved ; and which should also carry conviction 



REPORTS ON TYPHOID FEVER. 181 

to the mind of any intelligent physician who will care- 
fully and impartially weigh these reports and also my 
fuller treatises on the subject. 

While neither these accounts nor my own observa- 
tions have added anything to my knowledge of the power 
of this so-called "antiseptic medicine" to abort typhoid 
fever, when the treatment is commenced early in the 
course of the disease, they have served to convince me 
that in my original declaration I did not place too high 
an estimate on its value. They have done more — they 
have strengthened in my mind the belief that even in 
late stages of uncomplicated typhoid fever it has power 
to eliminate all ordinary causes of death, save the acci- 
dents of haemorrhage and perforation, and to minimize 
the danger of their occurrence. 

An analysis of the failures in a test of any given 
method is sometimes more instructive than an equal 
number of successes would be; and as that happens to 
be quite true in this instance, the following abstract of 
cases of typhoid fever, coming, as they do, from disinter- 
ested observers, may possess for this reason a higher im- 
port than would the report of a much larger number oi 
universally successful cases from my own practice. 

In one large hospital, in which the observer held an 
honorable position under the Government of the United 
States, several exceedingly serious cases of typhoid 
fever were aborted by the " Woodbridge method ; " but 
finally a death occurred, for which catastrophe I could 
find no excuse, until I discovered that the patient had 
taken at three-hour intervals the extremely minute d 
which I had advised to be given every fifteen minute 

An instance of the lack of that discernment so req- 
uisite in securing success in so difficult and delicate an 



182 REPORTS ON TYPHOID FEVER. 

undertaking is well pictured in the following quotation 
taken from the epistle of an apparently conscientious, 
just and high-minded gentleman : 

The patient had been sick several days; had a morbid 
appetite ; complained of being " so tired," chilly, headache, 
etc. . . . before consulting a physician. I gave 
him a simple laxative pill, containing colocynth, podoph- 
yllin, aloes, etc., which had a tremendous effect, so 
much so that I had to interfere with remedies. His 
temperature rose to 104i°. I pushed large doses of 
quinine upon him, and for two days the fever stayed 
away, and he got up and walked about the place. This 
was against my orders and he was soon compelled to go 
to bed. . . . Real typhoid tongue, some tympanitis, 
high temperature. I commenced giving him guaiacol and 
eucalyptol, as recommended by you, but mixed with bis- 
muth. . . . He was sponged freely; . . . given 
four ounces Walker's best whiskey. . . . He died 
that night at 11 o'clock. 

The writer closes this eight page account of his ex- 
periences with the " Woodbridge method " of treating 
typhoid fever with : " Now in this case your powder 
was not used — all your other suggestions were fol- 
lowed." Were they? The patient did not consult the 
doctor until he had been sick " several days," he was 
then given a "simple laxative pill, which produced a 
tremendous effect ;" then "large doses of quinine were 
' pushed' for two days," and finally he was given two of 
the ingredients of my formulas, but not those, which to 
his patient were a veritable "sine qua non," i. £.,"the 
play of Hamlet with Hamlet omitted." 

Thus, in these illustrations, one can easily see that 
not only were the minutiae of my instructions unmistaka- 



REPORTS ON TYPHOID FEVER. [83 

bly disregarded and neglected ; but the chief essentials 
were likewise overlooked to such an extent that neither 
these deaths, nor others occurring under like circum- 
stances, should be charged to the " Woodbridge treat- 
ment." 

Dr. Dodge, of Michigan, has written me several 
letters, which I consider most valuable contributions to 
current medical literature, and which I am unfortunately 
prevented from giving in full for want of space in the 
Journal. 

He says : "I have seen three fatal cases this year, 
but none of them were uncomplicated cases, though I 
presume none of them would have died, had it not been 
for the typhoid element. One case was admitted to the 
hospital in the second week, as near as we could ascer- 
tain. He said he had been sick two weeks ; and he had 
a temperature of 104J° when admitted. We gave him 
your formula No. 1, until free catharsis was produced ; 
then the guaiacol and eucalyptol combination in grad- 
ually increasing dosage, until he took 5 m. of g., and LO 
m. of e. every two hours. His temperature came down 
to nearly normal in a few days ; he had severe diarrhoea, 
and pain in the abdomen ; became wildly delirious ; then 
comotose, and died about ten days after admission. An 
autopsy revealed a great many ulcerated Peyer's patches 
and a general enteritis as well. The next fatal ca 
also admitted in the second or third week. It was im- 
possible to learn just how long he had been sick. He 
also had pneumonia when admitted, and in the course «>f 
a week succumbed to the two diseases. Autopsy showed 
ulcerated Peyer's patches in abundance. He was given 
the same treatment as the other case, in the same man- 
ner, with the addition of appropriate medication for 
pneumonic complication. The third case I saw in con 
sultation, and was in the private practice of Dr. B. The 
young man had been sick two weeks when Dr. B. was 



184 REPORTS ON TYPHOID FEVER. 

called, and had been starved by a quack who l starves 
fever/ He was reduced, and had a haemorrhage the day 
Dr. B. was called. I have had five other cases that 
have recovered. Two of them were aborted in the 
proper sense of the term, and in three, where the treat- 
ment was commenced about the tenth day, I am satisfied 
that the course of the disease was modified for the bet- 
ter. I have never before attended cases of equal 
severity that passed through the disease, and made so 
nice a convalescence as did these three cases. 

"Two cases (and they were the only two in which I 
was able to commence the treatment during the first 
week of illness) were certainly aborted. 

"One of them lived in a neighboring town. I visited 
him first one evening, and found that he had been sick 
four days and had a temperature of 103°. I gave him 40 
grains of quinine to be taken during twelve hours. The 
next night he had a temperature 103^°. I placed him on 
the powder in half hour doses for 24 hours, then 3 m. 
doses of guaiacol and 6 m. doses of eucalyptol every three 
hours. I did not see him for 48 hours, when he had a 
temperature of 100°. I did not see him at all after that, 
but he continued the g. and e. mixture steadily, and a 
week later came to my office when he had a temperature 
of 100° or a little less, and had an abundant rose eruption 
over the abdomen. I ordered him to continue the mix- 
ture as long as he had any fever, and I have not seen 
him since. 

" The other case simply had fever that did not yield 
to quinine, but was aborted speedily by your treatment. 
Some might deny this case being one of typhoid fever as 
there were no pathognomonic symptoms, but, at any 
rate, she had some kind of fever attended with diarrhoea 
and epistaxis. Quinine had no effect on the temperature, 
even in large doses, and the fever disappeared two days 
after the guaiacol mixture was commenced. ... I 
think the system may be so impoverished by the toxins 
absorbed in the blood that no treatment will avail to 



REPORTS ON TYPHOID FEVER. 185 

save the life of the patient, and the three fatal cases I 
have described may be considered as evidence support- 
ing this position. I have, however, great faith in the 
treatment when it can be commenced early, even in the 
second week I think -it will generally very favorably 
modify the course of the disease." 

An extract from another letter from Dr. Dodee, 
dated the 2d of April, 1895, is as follows : 

" All of the cases of uncomplicated typhoid fever that 
I treated in this manner recovered in a much shorter 
time than such cases have ever done with me before. 
The two hospital cases that died were complicated, the 
one with pneumonia and the other with severe enteritis, 
as the autopsy disclosed. The fatal case that I saw in 
consultation with Dr. B , should not properly be in- 
cluded in your list as he had been ' starved' by a homoeo- 
path for two weeks and had a profuse hemorrhage from 

the bowels before Dr. B was called. He died within 

forty-eight hours of the time I saw him, and, of course, 
there was no time to get him under the influence of your 
medicine. Our efforts were principally directed to 
stimulation, and to try to get him out of the state of 
collapse. Incidentally your formulas were administered, 
but without any idea that it was a fair case to try them 
in. I merely reported it to you as an instance of the 
terrible condition in which we sometimes receive these 
cases. 

" I also rather wished to warn you to dwell upon the 
necessity of giving your treatment early in the course of 
the disease, which you have done in later papers. I found 
some who thought from reading your papers that von 
claimed any case might be cured, no matter in what 
stage the treatment was commenced. I was well aware 
that you had not claimed any such thing, but I desired 
to call your attention to the fact that some persons had 
drawn that inference." 

Dr. C. N. Udell, of Iowa, wrote me on the 19th of 



186 REPORTS ON TYPHOID FEVER. 

April, 1894, seeking an outline of my treatment for 
typhoid fever. This letter was answered in its turn on 
the 3d of July. On the 25th of August I received a 
letter, from which I quote the following : 

"The first trial was with Case No. 1, Iva M., aged 
fourteen years. The enclosed chart will show you the 
range of the temperature. This was rather a grave 
case, with bad hygienic surroundings and poor nursing. 
I did not begin the antiseptic treatment until she had 
been sick nine days. She made a good recovery, but 
the case ran for some weeks and could not be called 
aborted. 

"Case No. 2. Frank B., was sick a week when I 
was called, and I diagnosed typhoid fever. He had the 
usual prodromic symptoms, with all the phenomena of 
true typhoid following. I put him on your formula No. 1 
and continued that most of the time. In' one week he 
was about well. 

"Case No. 3. Mrs. C, was employed as nurse for 
Case No. 1 in the latter part of her illness. She is now 
sick with typhoid, in rather a mild form, yet unmistak- 
ably typhoid fever. I think from the present indications 
she will run the course in about fourteen days. Treat- 
ment — Formula 1 is given most of the time; No. 3 when 
the bowels are too loose. I have been using the same 
treatment in cholera infantum with good results. I have 
procured what I supposed to be pure guaiacol and 
eucalyptol, but find it difficult to give this to children, 
the taste is so horribly bad. Some children strangle 
badly on it even in small doses. I begin to fear impurity. 
I believe your theory is correct." 

Dr. Udell sent me on the 22d of March another 
report of cases. He says : " I will give a brief report of 
cases, selected from amongst those treated with your abor- 
tive treatment for typhoid fever. In the management of 



REPORTS ON TYPHOID FEVER. 187 

these, as well as other cases, I relied almost wholly upon 
your prescriptions Nos. 1 and 3, giving- a diuretic occa- 
sionally when required ; also an occasional dose of bro- 
midia, when the patient was too restless to sleep at night. 

" Case No. 4. A. D., male, aged forty-two years. 
Suffered with all the prodromata of typhoid fever for six 
days, without treatment, with the exception of some 
domestic remedy. I prescribed R. No. 1 for three days ; 
No. 3 for four days ; and No. 2 on fourth day. Patient 
was discharged on the seventh day, with No. 3 to be 
continued at intervals of four or five hours for a few 
days. No relapse. Highest temperature in either of 
the above cases was 103.4°. No delirium or eruption. 

"Case No. 5. J. C, aged eighteen years. Taken 
just as Case No. 4 was, with feelings of weariness, lassi- 
tude, constant headache, fever, rigors, foul furred tongue, 
anorexia, slight nausea, nosebleed ; some diarrhoea and 
tympanitis and tenderness over the abdomen. I was 
called after the patient had been sick one week and found 
that he had taken some cathartic pills. Prescribed R. 
No. 1 for three days, No. 2 on the third day. No. 3 for 
one week, when the young man began to do light work. 
No relapse. 

Case No. 6. W. C, aged twenty years, (brother of Case 
No. 5). Symptoms much the same, so he was treated the 

same way as was his brother. No further treatment needed 
after six days. 

Case No. 8. D. B., male, aged twenty-one years, (brother 
of Case No. 7) taken with the usual premonitory symptoms of 
typhoid fever. Had taken some cathartic pills on his own 
notion. I gave him Nos. 1 and 2 and then No. 3 for five days 
and he was well and able to do light work on the farm. I 
let him eat anything and all he wanted. 

Case No. 12. Ellen P., female, aged forty-four years. 
Had been sick for three weeks with typhoid lever, under the 



188 REPORTS ON TYPHOID FEVER. 

care of another physician. The family and doctor were 
alarmed and were looking for perforation, or fatal haemor- 
rhage. I advised R. No. 1 every half hour for one day, then 
No. 3 every hour unless the patient was resting well. Gave 
bromidia at night if patient did not sleep. Improvement from 
the first dose of medicine. Patient sat up in bed on fourth day 
of my treatment and was doing some of her own house- 
work in two weeks. I insisted upon this patient eating 
proper food regularly after the first week. Recovery com- 
plete. 

Case No. 13. Ef. R., female, aged twenty-three years. 
Was taken with chills, fever ; had headache; backache; dysp- 
noea ; nosebleed ; anorexia ; very dark, strong urine ; a little 
blood passed from th e bowel. Temperature soon ran to 104.4° 
F. I prescribed R. No. 1 with frequent alkaline sponge baths 
and flushing of the colon every day with an alkaline wash. 
After two days, I left R. No. 3, but the patient would not 
take it to do much good. Gave very small doses with sugar 
of milk, and was compelled to continue very small doses of 
No. 3. Patient was up and walked to the dining-room on 
the fourteenth day. Took a relapse, and was confined to 
her room for ten days longer. Continued R. No. 3 in 
small doses. Patient made a good recovery, but was some- 
what fastidious about taking medicine, and of course I 
could not call this an aborted case. 

" Thus I have given a brief sketch of such cases as 
would be a fair sample of those treated with the ' Wood- 
bridge prescriptions.' The cases I failed to render 
abortive, were those who had endeavored to treat them- 
selves for one or more weeks, or those in which my 
directions were not carried out according to orders. The 
one fatal case was doubtless beyond all earthly help 
when I was called." 

On the 13th of August, 1894, I replied to a letter of 
Dr. H. G. Chritzman, of Pennsylvania, giving a detailed 
account of my method of treating typhoid fever. 



REPORTS ON TYPHOID FEVER. 189 

He wrote me on the 20th of December, 1894, a letter, 
from which I make the following excerpta : 

"I have had eighteen cases of typhoid fever this 
summer and fall. My last case was discharged well last 
week. In none of these cases was there intestinal 
haemorrhage, except the first, which I reported to you, 
and none have died. 

" The most of these cases were not wanting in 
virulency. I have charts of most of them, and the num- 
ber of days under treatment was from fifteen to twenty- 
four. 

" I find also that many of my patients had the dis- 
ease a week or more before coming under my care. I 
cannot agree with you in reference to the question of 
giving patients solid food.* Temperature under your 
method of treatment often becomes normal before the 
ulcers are healed. Care, therefore, should be used in 
the administration of solid food. I believe a perfectly 
clean and normal tongue is the indication for solid food. 
I found guaiacol exerts no disturbing influence on any 
organ, except in a few cases. An irritable stomach re- 
jected it, and those cases gave a little trouble for a 
while. I believe your antiseptic treatment is the rational 
treatment for typhoid fever. Under its influence the 
course of the disease is greatly modified; tympanitis is 
prevented, the tongue remains moist throughout the ill- 
ness ; delirium is rare and the intestinal tract is placed 
in the best possible condition for the healing of the 
wounds. I am certainly thankful that I discovered your 
articles in the 'Journal' 



*The doctor has misunderstood me. I have never advised physicians to 
allow typhoid fever patients " solid food." 



190 REPORTS ON TYPHOID PEVER. 

I quote the following letter from Dr. Balmer, also of 
Pennsylvania : 

" I have treated a number of cases of typhoid fever 
this summer by your method with remarkable success, 
and will endeavor to copy the temperature charts and 
send them to you soon. I presented these cases and the 
method of treatment before The Jefferson County 
Pennsylvania Medical Society at the last meeting, and 
I had introduced it previously orally in the society, and 
to individual members. Dr. S. M. Free, of Du Bois, Pa., 
one of our members, is very enthusiastic; also Dr. J. J. 
Brewer, of Clarington, Pa., who treated a number of pa- 
tients by the method at my suggestion." 

I very soon received a letter from Dr. S. M. Free, 
dated the 26th of December, 1894 : " I have used your 
plan of treatment in a few cases of typhoid fever. It is 
the best I have ever employed. I have tracings and 
fairly complete notes of my cases, and I am having my 
assistant make copies, which I shall take pleasure in 
sending to you as soon as completed. I trust that they 
may be of some service to you, for I am under great 
obligations to you for your great kindness to me. I 
am thinking of preparing a paper for presentation to our 
West Branch Medical Society on your plan of treat- 
ment, and will exhibit my charts and notes. Do you 
object to such a procedure ? I feel sure that the more 
we can induce to use the treatment, the less will be the 
mortality in typhoid fever." 

A quotation from a letter from Dr. H. K. Meyers, of 
Indiana, dated the 6th of January, 1895, is as follows : " I 
carefully tried your mode of treatment in three well- 
marked cases of typhoid fever, in the past few months, 
and was well pleased with it. Case No. 1. Girl, aged 



REPORTS ON TYPHOID FEVER. 191 

fourteen years. Very poor ; surroundings bad ; parents 
as ignorant as they were poor, yet willing to do as I 
directed. Temperature was from 104° to 105.2° F. ; 
bowels tympanitic, and very tender ; rose spots ; tongue 
literally dried up, and with red edges. During the first 
three days the nose bled almost constantly. I tried to 
carry out your treatment to the letter, and I think I suc- 
ceeded, as near as any one can carry out another's 
ideas. The temperature was normal on the eleventh 
day ; she made an excellent recovery. I should have 
stated that she had been sick a week before I was called 
in. The other two cases were treated in the same man- 
ner, and made good recoveries. While my success in 
treating typhoid fever has been fair in the past, the fever 
was always protracted and tedious. I think your treat- 
ment is correct in principle, and is bound to succeed." 

Dr. W. N. Sherman, of Merced, California, wrote me 
August, 1894, asking for more definite rules for the manage- 
ment of typhoid fever than I had given in my papers. These 
directions were sent on the 13th of September and on the 
29th he wrote me a letter from which I extract the fol- 
lowing : "I have given your remedies in a modified form, 
in two cases, resulting in a normal temperature in both cases 
on the eighth day. I am highly pleased thus far." Other 
letters followed reporting cases successfully treated, the last 
on the 6th of February, 1895, in which he says : 

"I am greatly pleased to inform you that I succeeded in 
inducing my patient to take your remedy, and this third re- 
lapse is yielding to the treatment promptly. As the bowels 
were somewhat constipated, I first gave 5 grains of calomel, 
followed by mineral water and sul. magnesia. These failed 
to establish catharsis, and I gave 1 oz. of castor oil with tur- 
pentine. I started with your combination No. 1 and kept it 



192 REPORTS ON TYPHOID FEVER. 

up all the time, and this morning (the sixth day) the tem- 
perature touched 98-8°, F. The patient has been able to sit 
up all the time and is cheerful and comfortable, a very marked 
contrast to the other attacks/' In another letter he kindly 
says : 

"You are at liberty at any time to use my name as 
one who has proved and practiced your treatment and 
believes it to be superior to all others." 

Dr. G. Law, of Colorado, published a paper in the 
Denver Medical Times of December, 1894, from which I 
take the following extracts : 

"Dr. John Eliot Woodbridge, of Youngstown, Ohio, 
read a paper on typhoid fever in the Section on Practice 
at the forty-fifth annual meeting of the American Medi- 
cal Association, San Francisco, June 5-8, 1894. I was 
present and heard the paper. . . . On looking over 
the action of the drugs named by Dr. W., I came to the 
conclusion that the carb. of guaiacol was the central and 
efficient agent, if there were any efficiency in the pre- 
scription. . . . Hence I framed a formula for my- 
self. . . . From the 25th day of July up to to-day, 
Nov. 23, I have treated thirty-five cases of typhoid fever 
without losing a single patient. I have not had a case 
in which the fever lasted beyond twenty days. I have 
had a number of cases where complete subsidence of 
fever had ensued at the end of fifteen days. 

" Cases that started with a temperature of 104° F. in 
the afternoon, after about four days of this treatment 
showed usually an afternoon temperature of 102° F. and 
a morning temperature of 100° to 101° F., with some 
sweating, which usually occurred about midnight. Not 
one of the thirty-five cases ever had a dry tongue at any 
time ; not one of my cases manifested the slightest 
delirium. It was not necessary to give any of these 
patients anything for the purpose of securing sleep or 
rest. Not a single relapse occurred in the entire num- 
ber treated. 



REPORTS ON TYPHOID FEVER. \\v.\ 

" The guaiacol compound was continued for one 
week after the total subsidence of the fever, but given 
every three, then four and, finally, every six hours. 

" In none of the thirty-five cases was there noticeable 
meteorism, or the slightest haemorrhage from the bowels. 
During the last twenty-four years I have seen and treated 
from twenty to fifty cases of typhoid fever each year. I 
never before treated thirty-five consecutive cases without 
losing a patient. I never before treated that number of 
consecutive cases without a relapse. 

u Typhoid fever during the present year (1894) in 
our town has manifested about the usual characteristics, 
with about the usual mortality, in the hands of practi- 
tioners other than myself. I saw several fatal cases in 
consultation with other doctors, but I did not regard 
them as being suitable cases for the " Woodbridge 
method of treatment," as they were almost, if not quite 
in articulo mortis. 

" I am not sanguine of the value of this treatment if 
instituted late in the course of the disease, after the nerve 
centers have become profoundly poisoned by the fever 
toxin. I have made no secret of what I was doing with 
reference to my work to my colleagues in our city. 
However, only Dr. R. F. Graham seemed to attach any 
importance to it. He has been giving the matter some 
attention, and I thank him for his courtesy and will leave 
him free to speak for himself at his own elected time. 
I am aware that the bright and brilliant lights in the 
profession have scouted the idea of there being any 
efficiency in the plan of intestinal antisepsis, and I will 
admit that it has not hitherto happened to be markedly 
successful. But let me ask, is it not in line with the 
present trend of so-called rational, not to say scientific 
medicine. In conclusion, I am inclined to infer that 
either I have had a remarkable and continuous sua 
sion of mild cases, or the treatment on the lines of intes- 
tinal antisepsis that I have steadily pursued during the 
time indicated have been remarkably efficacious." 



194 



REPORTS ON TYPHOID FEVER. 



During the recent epidemic of typhoid fever at Lorain, 
Ohio. I was called there in consultation with Dr. J. F. 
McGarvey whom I found was treating the disease by my 
method so scientifically, and so successfully, that I knew that 
time would give the "Woodbridge method" at least one 
more warm advocate on the shores of Lake Erie. The evi- 
dence convinced him more promptly than I expected, and 
now every few days he sends me the clinical chart of a pa- 
tient in whose case he has aborted the disease. 



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DR. McGARVEY'S CASE ARCHIE K. 



Your attention is invited to his chart marked, " Dr. 
McGarvey's Case." 

Dr. J. O. Yost, of Hazleton, Ohio, in whose family Dr. 
Bennett treated with me three cases of typhoid fever last 
autumn (see charts of Cases Nos. 92 and 96 — of the third 
case no chart was kept) has contributed a chart of a re- 



REPORTS ON TYPHOID FEVER. 



195 



markable case, in which he reduced a temperature of 106° 
to normal in ten days, when he reports the patient around 
the house, covered with rose spots. 

See Dr. Yost's case, marked Wm. McC. 



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Dr. Yost's Case. — William McC: residence, Hazleton. Date of admission, 
March 16, 1895. Commenced "Dr. Woodbridge's abortive treatment" Sunday 
evening— the first day the patient thought the services of a physician necessary- 
he had been complaining for five days before. Omthe tenth day he was covered 
with rose spots, and about the house. 

Dr. W. B. Shields, of Arkansas, under date of the 2d 
of October, 1894, says : 

"I have for some time past been keenly interested in 
articles from your pen which have appeared in the Journal 



196 REPORTS ON TYPHOID FEVER. 

of the A. M. A. in regard to treatment of typhoid fever. That 
you have struck the correct treatment, I am further convinced, 
not only by your own brilliant success, but by a very re- 
markable run on four cases which I treated in September, 
following your directions as nearly as possible. No one, it 
would seem to me, with intelligence would question the treat- 
ment after having tried it, especially with such testimonials 
as you have presented from those who cannot possibly be 
interested in your success. ... I think as you say, that 
possibly your treatment could and may be improved upon in 
the future, but not materially changed, and it will have to be 
carried out on the same lines. ... I was an Interne in the 
Memphis City Hospital nearly two years, and had a large 
opportunity of treating typhoid fever with ammonia salycil, 
but although it seemingly modified the disease, I have no 
recollection of one case being cut short. I have been in 
private practice for five years, and can't say that I have seen 
any better results than in hospital practice, my cases all run- 
ning from three to five weeks. These four cases I am just 
through with, in two of them with morning temperature 102° 
evening temperature 104° and 105° several times in the first 
week, were free from fever at the end of the thirteenth day of 
treatment and fifteenth day of disease. 

"One other case with evening temperature 103.5° and 
104°, several times was free from fever on the fifteenth day 
of treatment and seventeenth day of disease. 

"The last case had evening temperature of 104° and 
105° several times, was free from fever on the seventeenth 
day of treatment and twentieth day of disease. This 
last case had such a bad attack, as to suffer with incon- 
tinence of feces for several days. 

"All of these cases felt strong at the end of the 
fever, could walk around the house. 



REPORTS ON TYPHOID FEVER. 197 

11 With my limited experience in this treatment, I have 
to allow patients no solid food. I have used no coal 
tar derivatives whatever, but had my patients sponged 
off once or twice in the evening, on days when the 
fever was high. As you said, after two or three days 
of treatment their fever could be and was controlled by 
the antiseptics administered. I feel that with further ex- 
perience in this line I can have as good results as you 
have. These few cases which I present, few in number 
but brilliant in results, convince me that you have struck 
the keynote and whilst begging your pardon for mono- 
polizing your valuable time, I must return thanks for the 
great benefit I have seen result from your teachings." 

Dr. C. I. Burt, of Iowa, wrote me on the 10th of 
December, saying: 

" We are having an unusual epidemic of typhoid 
fever in our locality. I have at present some thirty- 
eight cases. Your antiseptic treatment was called 
favorably to my attention to-day by Dr. Wright, of Car- 
roll, Iowa, and he suggested that I write you for reprints 
of your late articles on typhoid fever. Our source of 
contagion is such that the physicians of this town will 
yet have to contend with some hundred more cases." 

Very soon after I received another letter (unfortu- 
nately mislaid) in which the doctor complained of his 
inability to secure the results I had promised, not- 
withstanding the fact that I had written him a long 
letter, giving him the fullest possible details of my 
method of procedure, but on the. 22d of January, 1895, 
I received another letter from which I make the follow- 
ing extracts : 

" I do not seem to get quite the promised result 
from the tablets, in the nature of producing effect, as 



198 REPORTS ON TYPHOID FEVER. 

stated in a previous letter, but am now having better 
success, and I now push them to their limit. However, 
I have at all times followed very closely your directions, 
and must state that the effects have been wonderful. In 
no instance have I failed in relieving my patients 
within three weeks, and often in two. In that time, 
understand, some of them were sitting up, others mov- 
ing about, and in a manner attending to their usual busi- 
ness. Many cases I commenced upon when the fever 
reached the 103° and 104° point. Of course, they had no 
serious intestinal lesion. However, when I discover the 
matter has passed to an intestinal infection I yet obtain 
splendid results. 

" Now, this point is one to which I wish to call your 
attention. Leaving out the abortive fact of your treat- 
ment, what are your results after the case has pro- 
gressed, even to haemorrhage ? I find, by pushing the 
treatment then as persistently as at any other time, that 
I obtain pleasant results, at least, a thorough intestinal 
disinfection, and in fact, a general better tone. Without 
doubt, Doctor, any one who uses your treatment, and as 
effectually as described by your directions, nothing but 
the most happy results will be the outcome. I have had 
several nurses from Omaha, and one recently from the 
Royal Infirmary from Dundee, Scotland, who is in this 
country for her health (they are all noted typhoid fever 
nurses), and let me tell you, they were absolutely para- 
lyzed that a country doctor could produce such effects as 
they had never seen in Omaha, or any city. They think 
they will go home now, and treat typhoid fever on their 
own account. They say the only objection they have to 
this treatment is, that it cuts off their time in nursing. 
In every instance I prescribe the full bottle, without eras- 



REPORTS ON TYPHOID FEVER. 199 

ing formula or attached notices. My nurses fully under- 
stand where the credit belongs." 

Another letter from Dr. Burt, written on the 21st of 
March, 1895, says : 

" I am still using your treatment and novv obtain all 
the results that you claim. I have a patient — one case 
reinfected four times within 18 weeks — under my care 
the last five weeks and strictly under your treatment. I 
have avoided any high jumps of fever from 104° to 106°, 
as had previously been the case. 

" My patient is now convalescent, but if I stop the 
treatment two days I note a rise of temperature, often 
from 103° to 104°. I am not experimenting further on 
this case, but rigidly keeping to the ' Woodbridge treat- 
ment/ and the happiest results follow. I note that you are 
to defend yourself. . . . It does not seem to me that 
one ought to produce a defense in the line of argument; 
if any of the gentlemen will permit themselves to follow 
out your instructions and use your treatment there 
would be no need of argument; they would all coincide 
with your views. It is just as positive that typhoid 
fever can be aborted by your method as it is that it can- 
not be by any other treatment to my knowledge. 

" I have had some sixty cases this winter, and there 
has been no mistake in the diagnosis, as our eminent 
local authorities have assisted me from time to time in 
the diagnosis. I note that some physicians criticise the 
fact that they can in no instance find the 'typhoid fever 
curve ' in your records ; were they to do this, after using 
the treatment a few days, the treatment then would be 
useless ; the treatment is to prevent this curve. It docs 
so, most satisfactorily. 

" Most of my cases have been among the poorer 



200 REPORTS ON TYPHOID FEVER. 

classes, and scarcely any attention was given other than 
the medicine. I have lost one case, but that was not 
under 'the Woodbridge treatment.' 

" It may no doubt seem an exaggeration as to the 
number of cases I have had and the happy results, but 
every fact can be verified. I have not kept a presenta- 
ble account of cases in children." 

At the last 1894 meeting of the Mississippi Valley Medical 
Association, I had read my paper on " typhoid fever," and 
during its discussion, which occupied three hours, my theories 
had been assailed in a most vindictive manner. Learned 
professors and editors of medical journals had vied with each 
other in making ungentle speeches. He who declared most 
positively in his harangue the time-honored aphorism 
"Typhoid fever must run its course of four, five, six, or ten 
weeks or longer," was most loudly and emphatically cheered. 
Of all the more than three hundred members in attendance, 
not one voice was raised in behalf of the principle I have so 
earnestly promulgated, or to give the slighest countenance 
to the treatment which will ultimately save an hundred thous- 
and lives annually in the United States alone. No man in 
all that assemblage dared or cared to say that "typhoid fever 
can be aborted" and to the end of the discussion I remained 
the single and lone defender of this great and fundamental 
truth that means so much to the human race. After the 
session adjourned, I was introduced to Dr. Dalton, of St. 
Louis, with whom I had had already some correspondence 
and who had written me (after having tested my method of 
applying antiseptic medicine to the treatment of typhoid 
fever) that he had been six years at the head of the great 
St. Louis City Hospital, through which 10,000 patients pass 
annually and he regretted that he had not then known of the 
"Woodbridge method." And Dr. Henry Clay Dalton 



REPORTS ON TYPHOID FEVER. 201 

healed all the wounds which that three hours' debate had 
given me, when he said; "lam very sorry that I was not 
at hand when your paper was under discussion ; I would 
have waited until those disputants had finished and then 
would have said ; ' Gentlemen I would like to inquire how 
many of you have used Dr. Woodbridge's treatment of 
typhoid fever ? ' and when they admitted that not one of them 
had (as they would have to do), I would have said : 'That 
is about as I expected; you have been endeavoring to dis- 
cuss a paper that you do not understand and a treatment 
you have never tried.' I have investigated this matter and 
know that the treatment will abort typhoid fever." Dr. 
Dalton has in various letters to me indicated his entire 
satisfaction with my therapeutic procedures, and has reported 
so many instances in which he has applied them, as to give 
assurance that the "abortive treatment of typhoid fever" in 
St. Louis is in a master's hands. Quotations from his last 
letter, written on the 25th of April, are as follows : " When 
I first tried your treatment for typhoid fever, I was a 
"doubting Thomas," but luckily the excellent result in the 
first case caused me to try it in a number of other cases, and 
I have not the slightest hesitation in saying that the treat- 
ment undoubtedly aborts the disease. Two months since I 
purposely allowed a typical case to run its course for eight 
days, using the old treatment. The temperature followed 
the general course, being a degree higher each evening. 
On the eighth day, I put the young man (eighteen years of 
age) on prescription No. 1, giving the powders every fifteen 
minutes for the first twenty-four hours, and every half hour 
for the next twenty-four hours. On the third day they were 
administered every hour and on the fourth clay, every two 
hours ; after that every four or five hours for a week. 

When I commenced the medicine, the temperature was 



202 REPORTS ON TYPHOID FEVER. 

103.5°. On the evening of the second day, it fell to 101°, 
and in two days more it was entirely gone, never to reappear. 
The bowels moved freely, six or eight times daily for several 
days. Ptyalism did not appear. I used no other treatment 
after commencing the powders. (Tablets.) Put me down 
as a firm believer in the treatment, an enthusiast in fact. 
Let the doubters try the treatment and be convinced. ,, 

The original letters and reports from which these ex- 
tracts are taken, and more than a thousand others on the 
same subject, as well as the original charts (of which you 
have been inspecting copies, many of them containing the 
verification and signature of the physician who attended 
the patient or who watched the results of treatment), are 
over at my hotel, all of which I shall be pleased to have 
you inspect. They contain much valuable information and 
would well repay a careful examination. 

I should like to have presented more of this unim- 
peachable testimony, but the line has to be drawn some- 
where, and these documents, with those I have already 
transcribed for presentation before the Ohio State Med- 
ical Society, should be amply sufficient to accomplish 
their purpose, especially since through the courtesy of 
Dr. Cunningham I have been able to exhibit the ana- 
tomic specimens, showing the ulcerated Peyer's glands, 
the tumefied mesenteric gland, and the intussusception 
which caused the death of the patient; and with them 
the clinical chart, kept at the bedside, in which the 
thermic line as it approached normal, indicates that the 
disease was aborted and the patient practically cured of 
his typhoid fever on the seventh day of treatment. (See 
chart marked Dr. Cunningham, Case No. 3.)* And 

*The report of Dr. Cunningham's case No. 3 (James K.) was taken from this 
paper to be reported to the Ohio Medical Society. 

The report of this case after having been read in connection with this paper, 



REPORTS ON TYPHOID FEVER. OQH 

if it be admitted that even one case of typhoid fever has 
been aborted, the total fabric of those who dissent from 
my views, reared as it is upon the antiquated and illogi- 
cal hypothesis that this specific infectious, this " self- 
limited, disease " cannot be aborted, is demolished. 

The reports heretofore made by me should have left 
no doubt as to the power of antiseptic medicine, nor do 
I believe they would have done so, could all or even 
two or three of the dozen papers I have written on this 
all important subject during the last few years, have 
been listened to and deliberated upon by one body of 
scientific men. They have, however, been so much 
diluted by their great distribution (having been read 
before so many widely separated societies, from the At- 
lantic to the Pacific) that very few physicians have heard 
more than one discussion of the subject, but when all 
these papers are gathered together and published under 
one cover, what Virchow calls " the brutal force of fig- 
ures" cannot but convince any thinking and unpreju- 
diced physician " That typhoid fever can be aborted." 
" Bis ac ter, quod pulcrum." 

Summarizing, you have my nineteen years of fairly 
satisfactory clinical experience with the method I have 
advised ; the last thirteen years without a death in my 
own practice from typhoid, malarial, or any continued 
fever, and as long practice added to my proficiency, a 
gradual reduction of the duration of the disease, as well 
as a lessening of the intensity and violence of the symp- 
toms. 



was presented and the anatomical specimens exhibited before the Ohio State 
Medical Society, in the transactions of which it will be published. This double 
report is fully justified by the rarity of the case, no other instance having ever 
come to my knowledge in which death has ensued after typhoid fever had been 
aborted, and because of its great value since it establishes the truth of my 
theories beyond question or cavil, in the court of final resort. 



204 REPORTS ON TYPHOID FEVER. 

You have the 800 cases, with nine deaths, reported by 
117 other physicians, some of whom have treated large 
numbers — as many as sixty cases through severe epi- 
demics, without a death — approximating my best results, 
and showing a grand total of 1,200 cases, taken at all 
stages of the disease, with only nine deaths, seven or 
eight of which were clearly due to grave complications, 
to the late stage of the disease at which treatment was 
commenced, or to faults of preparation or administra- 
tion of the remedies. 

The foregoing is a brief summary of the (at present) 
voluminous and cumulative evidence ; absolutely apo- 
deictic as to the possibility of aborting typhoid fever ; 
strongly presumptive as to the truth of the declaration 
that every case of the disease " can be aborted, and that 
death is a wholly unnecessary consequence," and more 
than competent to convict me of grave dereliction of 
duty, did I not impart my theories to the medical pro- 
fession in unmistakable language. 



TYPHOID FEVER.* 

Gentlemen of the Mitchell District Medical Society : 

I thank you for your invitation to come so far to ad- 
dress you. I fully appreciate the honor you have thus 
conferred upon me, and I accept it as an earnest of your 
interest in and anxiety to learn more of the strange the- 
ories which I have promulgated. I presume that you 
wish to know wherein my practice differs from that to 
which you are accustomed, as having been taught in the 
best medical colleges, and what it will accomplish, what 
caused me to discard the long cherished dogmas of my 
profession ; upon what substratum of fact my theories 
stand, and by what evidence they are supported. 

Since the year 1880, and especially during the past 
two or three years, I have presented such a redundancy 
of absolutely apodeictic evidence that "typhoid fever 
can be aborted," that any allusion here to that part of 
my subject may appear supererogatory ; but the medical 
profession, and through it the world at large, has become 
so thoroughly imbued with the reverse opinion and the 
sentiment expressed in the phrase, " Typhoid fever must 
run its course," forms so conspicuous a part of the medical 
literature of thisage — extending its baleful influence every- 
where— that it teaches the physician to regard the Ion- 
weeks of a living death, through which the victims of this 
disease must, under the "old regime," pass on a journey 

"Written for the Mitchell District Medical Society, West Baden Mineral 

Springs, Ind., July, 1895 (not read). 

205 



206 TYPHOID FEVER. 

which he can neither arrest nor guide nor select the final 
halt ; as a period in which his own uselessness is so ap- 
parent that not only he exalts the nurses' and degrades his 
own sphere ; but the patient, if he have sufficient conscious- 
ness, and the friends, also, learn to place a higher es- 
timate on the services of the nurse than upon the skill of 
the physician. 

Indeed, the denunciation of Mephistopheles in Faust, 

" Of medicine the spirits caught with ease 
The great and little world you study through, 
That things may then their course pursue 
As Heaven may please," 

is but slightly, if at all, at variance with the teachings 
and practice of the mass of the medical profession, and 
it can scarcely be condemned for its severity when ap- 
plied to the "symptomatic treatment of typhoid fever.' 1 ' 
This may seem an unjust arraignment of the medical 
profession, but I know of no professor of the "Principles 
and Practice of Medicine " in any medical college in the 
whole civilized world, who teaches that it is possible to 
"abort typhoid fever." Nor do I know of any medical 
text -book which directly or by implication admits that such 
a result is obtainable, or does not educate its pupils to 
put their faith in the apochryphal dogmatisms of an age 
entirely ignorant of the pathogenesis of the disease. I was 
told that the distinguished French Professor, Bouchard, 
taught that " typhoid fever could be aborted," but in his 
latest work I find that he denies the possibility of at 
once destroying the pathogenic agent. He says that 
" we must reckon with the fever," and adds : " We are 
here in the presence of a continued fever, which is with- 
out intermission destroying the patient for weeks." 
Moreover, the recent appearance in his own country 



TYPHOID FEVER. 207 

of an exhaustive work on typhoid fever (La Fievre 
Typhoide) in which rational (antiseptic) treatment is 
most unintelligently discussed, and the Brandt method 
lauded, would seem to indicate that even the very con- 
servative teaching- of this distinguished professor has 
not met with the welcome to which it is entitled among 
his own people. 

Notwithstanding all of this positive testimony to the 
contrary, the fact that I have been " aborting typhoid 
fever " can be questioned only upon the hypothesis that 
all of the patients whom I have treated for " typhoid 
fever" since 1882 (and nearly all since 1876) were the 
subjects of mistaken diagnoses ; that during all the in- 
tervening years I have happened to have only " mild or 
abortive cases of typhoid fever ; " that I have had no 
typhoid fever at all to treat ; that all of the physicians 
who have confirmed my diagnoses were mistaken ; that 
all of the physicians who have called me in consultation 
to see cases of typhoid fever were incompetent ; that all 
of the 123 physicians who have reported about 900 cases 
have been in error when they supposed that they were 
" aborting typhoid fever ; " that virtually all of the (partly 
estimated) 1300 cases of typical typhoid fever treated 
antiseptically happened to have been some other disease, 
because they recovered in a few days ; that in the worst 
epidemic of typhoid fever of which I have any knowl- 
edge, all of the cases taken sick within eight days before 
my arrival, happened to be exceedingly mild, while those 
who were ill earlier or later were exceedingly severe, 
and, finally, that this antiseptic treatment for typhoid 
fever is practically applicable to the cure of some occult 
disease so like typhoid fever, that not myself only but a 
large number of physicians supposed to be competent 



208 TYPHOID FEVER. 

diagnosticians, have been unable to make a differential 
diagnosis between them. The hypothesis is absolutely- 
untenable and its indefensibility will be rendered more 
apparent by a brief history of my work. 

On the 29th day of August, 1876, I was called to at- 
tend the young daughter of the President of the First 
National Bank of Youngstown, Ohio. She presented 
well-marked symptoms of typhoid fever, and on my 
second or third visit I made a diagnosis in accordance 
with the indications. In a very few days the patient 
was well. In the meanwhile, a young son had also been 
attacked and presented exactly the same symptoms. I 
have no complete record of this case, but it is indelibly 
impressed upon my memory as the severest, long-con- 
tinued case of typhoid fever I have ever treated. His 
temperature reached 107° F. It was 106° several times 
and it rose above 105° every day for weeks. His wild 
delirium and incoherent ravings were piteous, indeed ; 
his extreme exhaustion, extending over a long period of 
time awakened the keenest anxiety. The long weeks 
during which he lay on the very verge of the grave was 
a time of weary watching for his parents and friends and 
especially for his physician. In compliance with • the 
earnest solicitation of his parents I slept in the house 
for weeks, to be near at hand in case of emergency. 
During his early convalescence his craving and begging 
for food were sorrowful to hear, and when he finally 
crawled out of bed he was so emaciated that his lips 
would cover neither his teeth nor gums, and his old 
vigorous boyhood seemed a long way off when, on the 
27th day of December, after 120 days of sickness, and 
then scarcely able to walk, I discharged him cured (if 
that may be called a cure in which the constitution has 



TYPHOID FEVER. 201) 

been destroyed, stalwart youth converted into almost 
helpless debility, and the functions of some of the or- 
gans, perhaps, permanently deteriorated). I felt more 
pride (so strangely is the human mind formed) in look- 
ing on that almost total wreck of a young life than I 
would to-day on a dozen severe cases which were re- 
stored to perfect health in ten or twelve days. 

During the illness of this young man, another son 
and two servants of the house had very severe attacks 
of the disease. The father and still another son pre- 
sented the same characteristic symptoms of typhoid 
fever, but they recovered in longer or shorter periods, 
and these were undoubtedly "abortive" or "aborted" 
cases of typhoid fever, such as present themselves to 
every practitioner who treats many cases of the disease. 

These cases, all occurring in one house, exhibiting all 
grades of violence, from the most pernicious type con- 
sistent with ultimate recovery, down through all of the 
gradations, to the "abortive type" in so mild a form as 
to render a precise diagnosis impracticable, awakened a 
deep interest in my mind and led me to wonder why, if 
nature could give complete immunity from all evil and 
deleterious effects of the poison of typhoid fever to 95 
per cent of those exposed to its malign influence, 
why should not the science of medicine aid her by curing 
the insignificant few which she fails to relieve. 

It seems to me a ridiculous and presumptuous as well 
as an illogical position which the medical profession as- 
sumes in recognizing the power of nature unassisted, to 
abort typhoid fever by giving this name, "abortive type, ' 
a place in the nomenclature of diseases, and then to delic- 
to all medicine the potentiality to assist her a little in her 
endeavor. Nature's work is thereby accepted, given an 



210 TYPHOID FEVER. 

appellation and an honorable place in the list, while man, 
going a step farther and doing for all cases that which 
nature does for a few, and regardless of the erroneous 
teachings and moss covered prejudices, applying the right 
name to his work at the expense of the destruction of 
what has always been considered awell-established axiom, 
is looked upon as an iconoclast. 

Ten years before the occurrence of the above men- 
tioned incidents, I had given much thought to the appli- 
cation of antiseptic medicine to the cure of microbic dis- 
eases, and had in 1866-7, treated a few cases of cerebro- 
spinal meningitis and erysipelas with the sulphites, with 
no very wonderful results, truly ; but since, theoretically, 
antiseptic medicine offered the only hope for the misera- 
ble beings who are the prey of typhoid fever, I turned 
all of my attention to this field of investigation, and very 
soon had abundant opportunity to study the disease 
clinically and to test my theories. The narrative of my 
failures or partial successes with all of the various agents, 
from turpentine and the sulphites to iodine, which were 
one after another used and abandoned, would be a 
waste of time and space, and would I fear exhaust the 
reader's and hearer's patience, although it might save 
future explorers the trouble of testing unreliable anti- 
septics. The only one of these earlier remedies which I 
still occasionally use is turpentine. Creosote has been 
displaced by its active principle, guaiacol, and that by 
the more potent and nontoxic guaiacol carbonate. It 
was long before I dared to use the saline or vegetable 
cathartics, on account of the strong condemnation of them 
by some of the best authorities, notably Harley in " Rey- 
nold's System of Medicine," who says " the vegetable 
and saline cathartics must never be employed in the 



TYPHOID FE VER. o \ \ 

treatment of the disease at any period ; . . . calomel 
should be avoided ; its action is too irritant." I consider 
this the worst advice that could possibly have been 
given. Were I limited to two remedies in the treatment 
of typhoid fever, I should select one of these despised 
drugs for one of them. Yet the article was written by 
a most eminent and trustworthy writer; by one who had 
had large experience in the London fever hospitals, and 
I had not at first the courage and fortitude to ignore his 
advice, but in the end I became thoroughly dissatisfied 
with all of these other medicaments ; so I began using 
exceedingly minute portions of the mildest of the salines 
and mercurials, and as continued observations added to 
my perception of the great importance and assistance they 
would eventually be to me, I began to use all of them 
more heroically. 

While learning my lesson in the dear school of ex- 
perience, I saw many melancholy and calamitous scenes, 
one of which is ineffaceably engraved upon memory's 
tablet. A brilliant and beautiful young school girl had 
an exceedingly distressing and unique attack of typhoid 
fever. I was first called to see her at 10 o'clock A. M., 
and was told that she had felt as well as usual in the early 
part of the morning, and had attended to some light 
household duties. Her temperature was 106° F., her 
pulse bounding and 160, her face flushed. She com- 
plained of an intense headache. I attempted no 
diagnosis at that time, but prescribed the medicine to be 
given, and left the house to find my uncle, Dr. Timothy 
Dwight Woodbridge, a gentleman of unusual ability and 
more than half a century of experience in the practice of 
medicine. He has since deceased. On returning to 
the house we found her temperature 107°, pulse uncount 



212 TYPHOID FEVER. 

able, and she had become absolutely unconscious. Dur- 
ing her illness she had repeated haemorrhages ; was ill 
nine weeks ; asthenia so pronounced that on returning 
one evening I found the nurses (two nuns) and all of the 
relatives and friends sitting around the large room, 
waiting for her to breathe her last breath. My ques- 
tions were answered with the statement that she had been 
lying as I now saw her, apparently lifeless, for several 
hours. Nictation had become so infrequent that the con- 
junctivae were dry and glazed. No respirations were per- 
ceptible ; the heart beats were inaudible, and she was to 
all appearance dead. The nurses did not think that she 
ought to be tortured any longer to prolong a life which 
could not possibly be extended many hours. I immediately 
resorted to every known means of stimulation, and had the 
satisfaction after several hours to see her breathe deeply 
once more, and half an hour later swallow a few drops of a 
mixture of brandy, ammonia and water. She finally re- 
covered, but was unable to continue her studies. She felt 
that her mind was gone and she wished she was dead. 

I did not feel so proud and so much elated over my 
work after hearing her sad remark as I had a few months 
before, when I had discharged her, cured (?). During her 
illness, her mother and sister both had mild attacks of 
typhoid fever, which I think were greatly modified, if not 
actually aborted by antiseptic treatment. 

A succeeding six years passed. My patients continued 
to have intestinal haemorrhage, and three died after that 
accident; but I was groping blindly through the black 
night of ignorance to the dawn of a brighter day. 

I learned to exhibit my antiseptics more intelligently, 
and to add one ingredient after another to my prescriptions, 
eliminating such as seemed to accomplish no useful pur- 



TYPHOID FEVER. 213 

pose. I could see that although I was not cutting the dis- 
ease off entirely, I was having better results, both in a 
lower death rate and a shorter duration of illness. Even 
in those cases that ran a tedious course, my patients 
showed the effect of the better treatment in that they had 
less delirium ; a generally lower temperature ; less tym- 
panitis ; very little troublesome diarrhoea ; a good condi- 
tion of the nervous system, evidenced both by the lack of 
severe symptoms and also by the fact that they slept well ; 
by a good pulse ; a moist tongue ; by a general feeling of 
comfort; and above all, by rallying rapidly. Health was 
quickly regained, with strength and hearty appetite. All 
of these things had been seen over and over again for 
more than twelve years before I dared to announce to my 
profession that "typhoid fever could be aborted," and then 
not till I had satisfied myself that every typical case which 
came under my care as soon as a diagnosis was practicable 
could be aborted in ten or twelve days or less, and that in 
cases in which treatment was begun too late to abort the 
disease, it could be so modified in its course as to leave no 
doubt on the mind of any unprejudiced man capable of 
drawing correct conclusions from given facts, that I could 
do all that I promised, that I was satisfying every ex- 
pectation awakened by my most favorable prognoses. 

With the white light of professional jealousy turned on 
my work and every penny-a-liner and psilologist writing in 
defense of the well-nursed dogmas of the days of yore, 
with the medical profession and the people watching me, 
with the knowledge that I have always courted the fullest 
investigation of my work and that I have always held my- 
self in readiness to have the experimentum cruris applied 
to my theories in hospital or in private practice, at home or 
abroad, these facts should be regarded as final and decisive 



214 TYPHOID FEVER. 

proof that " typhoid fever can be aborted ; " leaving out of 
consideration the extreme folly of which one would be 
guilty, who would, without the most indisputable ground of 
belief, or indeed of positive knowledge of the invulnerable- 
ness of his role, take issue with those who from time imme- 
morial have maintained utterly antagonistic ideas. It must 
be quite clear to the most casual observer of the trend of 
medical thought that if all this could not have been done, I 
would have been driven from my place in the medical pro- 
fession as an impostor long ago. 

It was fortunate for me however, that a little army of 
brave men, a forlorn hope, in defiance of the ridicule they 
must face, if in the end it should appear, that all the great 
master minds of the medical profession are right, and I am 
wrong, and that typhoid fever cannot be aborted; have 
written me, declaring their perfect conviction of the correct- 
ness of my teaching. Some of them in giving in their ad- 
hesion to the treatment, have deliberately used language as 
strong as that which I have been so severely criticised for 
uttering in the heat of debate. In extenuation of their faults, 
and of mine, this plea should be allowed, that when a phy- 
sician has for years treated typhoid fever symptomatically 
with the usual results ; has seen his patient pass from a 
bad state to a worse one ; has exhausted his resources in 
futile attempts to mitigate the horrors of his condition, sees 
him drifting to the great "beyond," and himself and all other 
agencies, powerless to impede his passage, and has then 
learned to so utilize antiseptic medicine, as to be able to meet 
the fell destroyer with such power to cope with the enemy 
as to assure always an easy victory ; it arouses in the most 
sluggish intellect, some enthusiasm. But when he sees that 
he may take charge of a patient, with a temperature of 
105°, or 106°, with all the other symptoms correspondingly 



TYPHOID FEVER. 



215 



bad ; and with perfect confidence that he is awakening no 
false hopes, by assuring the patient and his friends, that 
there is no danger of death, but that after a brief illness, at- 
tended by little discomfort, he will be able to resume his 
ordinary occupation, with all his faculties normal, and his 



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Taken from Murchison.] 



strength little if at all impaired ; he ma)', I think, be excu >ed 
for discussing the subject without much regard to eu- 
phemism, especially when he has been pestered by the criti- 
cisms of those who seem to know little of the pathology ol 
the disease, and less of its antiseptic treatment. 



216 



TYPHOID FEVER. 



I have exhibited all of the clinical charts that have been 
sent me by these physicians, and related the bedside his- 
tories of my own typical cases so frequently in the various 
societies in which I have read papers on typhoid fever, that 
their appearance must be familiar to every one who has 
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The above chart shows the average highest daily register of the temperature of cases of 
typhoid fever which were treated by the abortive method. The number of cases incduded in the 
daily averages is shown at the bottom of the chart. It should be noted that after the fifth day of 
treatment a certain number of patients were discharged each day with a normal temperature 
and the average is always of cases which are left uncured, hence the thermic line does not 
delineate the effect of treatment as favorably as it would were the record of the entire number 
carried to the end. 

decided to give a synopsis of the well-thumbed charts in one 
which will give the thermic line of the daily average of all 
the patients which I have treated by my method, so far as 
I have complete records, 122 in all, . . . and I present 
with it a chart of a severe case of typhoid fever, giving the 
thermic line after Wunderlich, copied from Murchison. 



TYPHOID FEVER. 217 

I regret that I have such incomplete memoranda, which 
is due to the fact that a great many of the physicians who 
have reported their general results with the abortive treat- 
ment in 900 cases, sent no charts, and of my own cases, I 
kept few complete records prior to 1893. 

A comparison of these charts will show you at a glance 
the effect of antiseptic medicine, and yet, not all of its effect. 

The tracing of Wunderlich conveys no idea of that which 
is known as the typhoid state. It does not show the patient 
in his rambling delirium, with a burning fever and a parched 
tongue ; with the necrosed and ulcerated Peyer's glands, 
with the enlarged spleen and the tumefied mesenteric glands, 
with the enormous tympanitic distention ; with the not in- 
frequent accidents of intestinal haemorrhage and perforation 
or the grave complications and the fatal termination. Nor 
does the thermic line in my chart show as I wish it might 
do the absence of all of these hideous symptoms and com- 
plications. 

If it could present the picture in its true coloring the 
patient would be found three or four days after the institu- 
tion of efficacious antiseptic treatment, with all of these 
graver symptoms in abeyance, free from ache or pain ; sleep- 
ing the sleep of health ; hungry for food which the system 
is quite capable of assimilating ; anxious to take outdoor 
exercise which is always allowed as soon as it is certain 
that there will be no necrosis of Peyer's glands. In fact, in 
all respects a perfectly comfortable invalid who will be; ready 
to resume the active duties of life, with the strength and all 
of the mental faculties unimpaired, as soon as the tempera- 
ture has touched normal and remains there. 

Assuming that the medical profession has recovered 
from the shock occasioned by my first modest announce- 
ment " that typhoid fever can be aborted" and "that (hath 



218 TYPHOID FEVER. 

is a wholly unnecessary consequence of the disease ; " I 
wish to open up to-day a new field of discussion, a fruitful 
field, which I have cultivated and gleaned as carefully as the 
limited means at my disposal would permit, and to which all 
of my papers on "typhoid fever" have been but a prelude. 

I allude to the application of the same general principles 
which govern the antiseptic treatment of typhoid fever, to 
the cure of a large class of the so-called "microbic diseases " 
such for instance, as diphtheria, scarlatina, pneumonia, chol- 
era infantum, la grippe, smallpox and probably many dis- 
eases of which I have no practical knowledge. 

As far as my experience can be relied upon as a criterion, 
it seems to indicate that a very considerable number of the 
diseases which are supposed to be of microbic origin yield 
far more readily, cause much less anxiety and suffering, and 
no impairment of the constitution, are accompanied by fewer 
and much less grave complications, and are followed by a 
much lower death rate under a judicious antiseptic treat- 
ment than by any other known method. 

For these reasons alone, antiseptic medicine should com- 
mend itself most highly to the medical profession. It has 
however other charms which endear it to my heart, promi- 
nent among which is its benignity, it being so harmless that 
I know of no pathological state at all resembling any of 
these conditions in which any one or more of the, ingredients 
that constitute my armamentarium, would do the slightest 
injury to the most feeble patient, were a dozen doses admin- 
istered at once. 

This statement must sound strangely paradoxical to the 
gentlemen who have been seeking for antiseptic remedies 
among the most virulent and dangerous poisons known 
to toxicologists. It is difficult to understand just why this 
rash and pernicious practice should have become so com- 



TYPHOID FEVER. 219 

mon among a certain class of physicians whose remedies 
unquestionably often placed the lives of their patients in 
greater jeopardy than did the disease; and I have no 
doubt you all know of cases of typhoid fever, diphtheria and 
other maladies which owed their fatal ending, not to the ail- 
ment, but to the corrosive sublimate or other poisons ad- 
ministered. Those who pursue this senseless course, do so 
under a mistaken idea that human life and germ life are 
governed by the same laws. It is well known that many 
bacteria are destroyed by substances which are entirely in- 
nocuous to man, and that others are unable to live in the air 
we breathe. A notable instance of the former class is the 
"hematozoa malariae," which although found circulating in 
the blood and permeating the spleen and other organs, are 
quickly eliminated by doses of quinine so small as to pro- 
duce no other appreciable effect. 

In. the treatment of zymotic affections, it may be and 
probably is not necessary to kill all, or possibly any of the 
germs which cause the disease ; some respect should be 
paid to the "vis medicatrix naturae" and in arranging our 
line of battle, we should give due consideration to the fact 
that in man the protective alexins need little aid to guard 
him from all ill effects from germic attacks, and if we but re- 
inforce them by weakening the enemy, we will have done all 
that is requisite. 

But little as seems to be demanded of us, it must be 
remembered that typhoid fever has through all time resisted 
successfully, not antiseptic treatment alone, not the feeble 
efforts of the weaklings only, but all of the resources of the 
giants of the profession ; and no one must imagine that he 
who would abort this masterful disease will have an easy task, 
or without especial training will be invariably successful. 

Notwithstanding my nineteen years of careful study and 



220 TYPHOID FEVER. 

experience, despite my unremitting vigilance; my care that 
every remedial agent exhibited was pure, active and prop- 
erly prepared, I have made so many mistakes, that in look- 
ing back only a very few years, I can see that "vigilance" 
stands not least among the causes that have saved me 
from having a death from typhoid fever for more than thir- 
teen years. 

I therefore insist that it is but just that in any future 
measurement of the value of the treatment I advise ; that 
these facts should be given due weight, and that one suc- 
cessful abortion of the disease should counterbalance an 
hundred failures ; for example, the twenty-five cases of 
typhoid fever aborted by Dr. Reed are of more worth as 
evidence that the disease can be aborted, than would be 
2,500 failures as evidence that his results were impossible. 
Although up to the present time, there have been very few 
failures reported to me, and but two condemnations of the 
" Woodbridge treatment " from that cause, it must not be 
expected that the reports will always be so one sided. 

It is greatly to their credit that so many physicians have 
succeeded so well, under the brief outline of treatment that 
I have been able to give ; and although I shall in a few 
weeks publish a treatise on" Typhoid Fever and its Abortive 
Treatment" in which I shall give the management of the dis- 
ease in detail, and shall make an effort to tell all I know on 
the subject, I shall be greatly surprised if, after the medical 
profession in general attempt to follow my directions, there 
are not reported many failures to secure satisfactory results. 

I believe there are two ways in which the " Woodbridge 
treatment" of typhoid fever and allied diseases, in all of its 
minute details can be fully imparted, and that is by clinical 
teaching in consultation or by clinical lectures. By the 
former method I have already made a few physicians abso- 



TYPHOID FEVER. 221 

lute masters of the disease, and as soon as I can encompass 
it I shall, either at home or abroad, open a hospital in which 
I will teach those who honor me with their attention, 
not the " abortive treatment of typhoid fever" only, but the 
application of antiseptic medicine to the cure of some of the 
most dreaded of the zymotic diseases. 



TYPHOID FEVER AND ITS ABORTIVE 
TREATMENT.* 

Gentlemen of the Society: 

You who were present at the last meeting of this Asso- 
ciation at Hot Springs a year ago ; heard your most dis- 
tinguished members flood that great hall with their elo- 
quent speeches in denunciation of my declaration that 
typhoid fever could be aborted; heard my silver-tongued 
friend on the right declare that typhoid fever " must run its 
course of four, five or six weeks or longer, uninfluenced by 
any known drug;" heard the peroration of that other gen- 
tleman when he argued that because my cases were aborted 
they were mistakes in diagnosis, heard all of these im- 
passioned harrangues, which were received with ovations 
of applause, and despite the fact that there were more than 
300 members in attendance, so many of whom were 
anxious to join in the discussion that your President was 
at last forced to peremptorily close the debate, when not 
one voice was raised in behalf of my theory, you may 
imagine that I met with, in your society, an unique recep- 
tion. This is not so. I have presented reports of aborted 
cases of typhoid fever before a large number of medical 
societies, and my experience justifies the conclusion that 
the same declaration would be met with a like greeting if 
read before any gathering of well-informed medical men, 
anywhere in the world, and that your orators simply 
showed themselves well versed in the literature of the sub- 

*Read before the Mississippi Valley Medical Association, Detroit, Michigan, 
September 4, 1895. 



ABORTIVE TREATMENT. 223 

ject, a blind guide which they may be excused for follow- 
ing until it has been rewritten. 

With this object in view, the first query would be : Is 
the ancient assumption of the medical profession that 
"typhoid fever cannot be aborted," in defense of which so 
much eloquence has been expended; is this belief really 
sustained by our present knowledge of bacteriology? More 
than two centuries have elapsed since, in 1673, the 
microscope was, by Leeuwenhoeck made to show living 
germs in the alvine dejections, and therapeutists have had 
ample time to profit by the discovery ; but is any one 
ready to say that the accepted treatment of typhoid fever 
in this year, 1895, is more scientific than it was when in 
1864 I sat so long, so many weary hours, over the micro- 
scope, studying cell development and cell metamorphosis, 
of which we then knew so little. Giant strides have been 
made in the science of bacteriology since a dignified pro- 
fessor and your humble servant on one bright Sunday morn- 
ing in the latter year, trundled heavy scales through the 
streets of Cleveland, down into the basement of the court 
house, to weigh the body, the liver, the spleen and other 
organs of a man (who had been shot down in the vigor 
of manhood and health) and carried away other portions 
of them for microscopical examination. We realized then 
that the microscope would reveal to us new worlds of 
which we had not even dreamed. 

We sought then in the sputa and the lung for the cause 
of tuberculosis; in the urine and kidneys for nephritic 
derangement; in the buccal cavity, the blood, the feces 
and the intestines for the pathogeny of typhoid lever; and 
in the blood, perspiration, etc., for what Laveran has since 
found, the hematozoa malariae. (A year or more later tin- 
above mentioned professor published a treatise on his 



224 TYPHOID FEVER AND ITS 

microscopical studies of typhoid and malarial fevers, tuber- 
culosis, etc., so that our investigations did not quite go for 
naught.) 

Bacteriologists have delved for the origin of typhoid 
fever in microbic fields more industriously and successfully 
than the general practitioner could possibly have done, and 
they are undoubtedly entitled to the most honorable men- 
tion for the noble, far-reaching and promising issue of their 
bewildering and arduous task. 

Escherich, who first described the bacillus coli communis; 
Eberth and Koch, who each independently of the other, 
discovered the mobile rods, with their thin, viscoid coating, 
since known as the bacillus typhosis or the bacillus of 
Eberth ; Gaffky, Klebs, Friedlander, Meyer, Fischl, 
Browitz, Sokolof, Klien, Recklinhauser, Brieger, who iso- 
lated and described typho-toxin ; Pfieffer, who has proba- 
bly come nearer than any one else to an actual demonstra- 
tion of the pathogenic nature of the bacillus typhosis ; and 
a host of others, including our own Sternberg, form a 
galaxy of stars whose names and deeds will live forever. 

The revelations of their microscopes followed each other 
in quick succession. Sometimes it seemed as if the patho- 
genesis of typhoid fever were truly written ; but the appar- 
ently fixed fact of to-day became the moot question of to- 
morrow. 

The germ, to whose presence in man is accredited, by 
one observer, the most dread disease, is by another taken 
with impunity. That which was supposed to cause a path- 
ological state, is found to be the prime factor in its cure. 
What was supposed to be harmful is found to be beneficent. 
The bacillus typhosis — the bacillus of Eberth — has been so 
long and so generally accepted as the cause of the disease, that 
the wisdom of questioning the proof may be well impugned, 



ABORTIVE TREATMENT. 225 

but the characteristics of this microbe and those of the 
bacillus coli communis are so interwoven with each other; and 
the signs that have been supposed to be pathognomonic of 
one or the other, have been found in so many instances to 
be common to both, that it is impossible to ascertain any 
unequivocal evidence that the bacillus typhosis may not be 
the bacillus coli communis virulized by some occult poison. 

If then, in this year 1895, after all of the deep researches 
of these studious painstaking and expert scientists and 
scholars, we are still without such exact data as would war- 
rant us in giving a name to the pathogenic agent of typhoid 
fever — what title best befits him who first announced the in- 
curability of the disease? — and what say you of a learned pro- 
fession, which without inquiring upon what special knowledge 
it was made, accepted such a damnable prediction and al- 
lowed it to stupify the brain and paralyze the hand of every 
investigator ; allowed itself to become particcps criminis — 
thus assuming the responsibility of every death from typhoid 
fever since the day on which the discovery of a curative 
treatment would have been made, had the hateful and blight- 
ing vaticination never been issued. 

While we cheerfully and gladly acknowledge our in- 
debtedness to the bacteriologists for their tireless and by no 
means fruitless investigations, it must be confessed that their 
wonderful discoveries have not been productive of such 
marked advancement in practical medicine as we had a right 
to anticipate, especially when encouraged and stimulated by 
Flint, who in his " treatise on the principles and practice oi 
medicine" said "it is not an unreasonable expectation that 
an antidote or a parasiticide as effective in typhus and ty- 
phoid fever as quinine in malarial fever, may hereafter be 
discovered, and such a discovery is a proper aim lor con- 
tinued experimental observations." 



226 TYPHOID FEVER AND ITS 

The patient, sinking lower and lower from typhoid fever 
would not be greatly edified with a dissertation on the find- 
ing of the bacillus typhosis and its toxins, only to be told 
that the "disease must run its course" that as Wilson in 
1881 said: "No medicine or method of treatment by which 
enteric fever can be arrested is at present known " that from 
10 to 20 percent of those attacked by typhoid fever die, that 
if he fall within that category he too must die, because "the 
known resources of therapeutics do not afford means for the 
arrest of these fevers (typhus and typhoid) , nor even for 
shortening the duration of the febril career." (Flint). 

[The remainder of this paper is inserted in this book under its appropriate 
head of "Treatment."] 



DIAGNOSIS. 

Symptomatology. — In making an analysis of the more 
important symptoms of typhoid fever, I have arranged them 
in the order in which they occurred to my mind, endeav- 
oring to think of and describe the more important ones 
first; but it is not claimed that they are all arranged in 
that order. 

The rose spots — the "taches roses, lenticulaires " of 
Louis — constitute the most truly pathognomonic symptom of 
typhoid fever to be found during life; they are rounded, 
slightly elevated, convex, not acuminous, not indurated, pur- 
plish or rose colored spots. They vary from one-half to two 
lines in diameter. They have well-defined regular margins ; 
they disappear on pressure and reappear quickly when the 
pressure is removed ; it is rare tnat a minute vesical forms 
at the apex. They have been known to appear as early as 
the second day of the disease (see report for 1888 and 1889 
of Dr. John B. Hamilton, Supervising Surgeon-General of 
the United States Marine Hospital Service), and in other in- 
stances they make their appearance for the first time late in 
the course of the disease. They generally appear about 
the eighth or tenth day, fade away in three, four or five days 
and are replaced by a fresh crop, and so they continue, 
fresh ones coming out and old ones fading away. It is rare 
to see many of these spots at one time. I have seen a very 
large number of cases in which not more than a dozen spots 
would appear from the beginning to the end of the illness, 
while on the other hand I have seen the entire abdomen, 
chest and arms covered by crop after crop, and Murchison 

227 



228 DIAGNOSIS. 

says that he has counted repeatedly more than one thousand 
on one patient at one time and adds that several other cases 
in which they were equally numerous had come under his 
notice. These rose spots are found most frequently on the 
chest, the abdomen and the back ; they may sometimes be 
seen on the under side of the arms and on the back, when 
they cannot be found on any other part of the body. Various 
writers have called attention to the fact that they sometimes 
appear after a warm bath. The average duration of the 
eruption is about fifteen days, the spots generally disappear- 
ing when convalescence is fairly established. Under the 
abortive treatment of typhoid fever, it is not at all unusual to 
see patients walking about the house, or even on the street, 
an examination of whom would reveal an abundance of char- 
acteristic rose spots. This symptom being absolutely pa- 
thognomonic of the disease, it is to be regretted that it is not 
always in evidence. 

Murchison says : " Of 5,988 cases (of enteric fever), ad- 
mitted into the London Fever Hospital during a period of 
twenty-three years, they (rose spots) were noted in 4,606, 
or 76.92 per cent. In some of the other 1,382 cases, the 
fact of the spots not being observed, was probably because 
they were not looked for with sufficient care. 

" Louis observed them in 150 out of 177 cases, and in 
the remaining seventeen cases, he was unable to say that 
they were wholly absent, except in five of the cases." 

Surgeon General Hamilton's investigations show that 
the eruption was absent in 64 of 241 cases. "The earliest 
date (of their appearance) was the second day ; it (the erup- 
tion) appeared on the 3d day in 2 cases ; on the 4th day 
in 3 cases ; on the 5th day in 5 cases ; on the 6th day in 
8 cases ; on the 7th day in 21 cases ; on the 8th day in 17 
cases ; on the 9th day in 8 cases ; on the 10th day 18 cases ; 



DIAGNOSIS. 229 

on the 11th day in 11 cases; on the 12th day in 10 cases ; 
on the 13th day in 2 cases ; on the 14th day in 10 cases ; 
on the 15th day in 1 case ; on the 16th day in 3 cases ; on 
the 17th day in 4 cases; on the 18th day in 4 cases; on 
the 19th day in 1 case ; on the 20th day in 1 case ; on the 
21st day in 2 cases ; the date was not given in 45 cases." 

Dr. Osier says: "Rose spots were noted in 199 of 229 
cases, 86.9 per cent. In nine cases they were very abun- 
dant, occurring not only on the trunk, but on the arms and 
thighs. In one instance, a lad of fourteen, they were present 
on the face. In two instances there were small petechial 
spots." 

My experience corresponds with the oft expressed opin- 
ions of various writers, that the amount of eruption is no 
measure of the danger of the disease — if it have any sig- 
nificance at all, it is a favorable rather than an unfavorable 
sign. 

Temperature. — The one constant symptom which in my 
experience has been present in some degree in every case 
of typhoid fever, is a greater or lesser elevation of the tem- 
perature. An exact counterpart of the thermic line of a 
typical case of the disease, after Wunderlich (to whom we 
are so deeply indebted for having educated the profession in 
the use of the clinical thermometer), would perhaps present 
itself very rarely, even to a close observer of a very large 
number of patients. Nevertheless a steplike rise of the tem- 
perature with a morning, or — very rarely' an evening- re- 
mission of one or two degrees, during the first three or four 
days of the disease, is the most constant, and shares with 
headache alone, the honor of being the most characteristic 
symptom of this early stage of typhoid fever. The absence <>l 
the typical typhoid fever curve (so-called), is however, not 
negatively pathognomonic of the disease. I cannot agree 



230 DIAGNOSIS. 

with the author of " Typhoid Fever" in Pepper s system of 
medicine, who says; that a temperature of 104:°, F. (40 C.) 
at any time during- the first or second day, should exclude 
typhoid fever from the diagnosis. Greater variations from 
the typical typhoid fever curve, than would be a temperature 
of 104° (40 C), on the second day have been observed many 
times. Osier reports "two instances in which contrary to 
the general rule, the temperature reached the fastigium on 
the second day. One is the interesting case ... in 
which within twenty-four hours . . . the temperature 
rose eight degrees and then remained high. The other 
after seven days apyrexia rose more than seven degrees in 
thirty-six hours and did not reach normal for fifteen days/' 
I have seen one instance in which the temperature at 
nine o'clock in the morning- of the first day of the malady 
was 106° F. (41.1 C), and the pulse 160. 

An hour later my uncle, Dr. Timothy Dwight Wood- 
bridge, examined with me this patient and we found the ther- 
mometer registered 107°, F. (41.6 C), and the pulse was 
absolutely uncountable (see report of the case of Orrie W). 
If the abortive treatment really aborts the disease, we should 
expect the period of fastigium to move backward in propor- 
tion to the rapidity with which the malady is cured. And 
this we find to have been accomplished in my cases, for 
whereas, Dr. Osier reports as something- very unusual the 
fact that two cases out of 229 reached the fastigium on the 
second day of the disease, 82 of 151 aborted cases had 
reached the fastigium on the second day, and 53 of these 
were at the acme of the temperature on the first day of ob- 
servation. That my cases were not unusually mild, is 
evidenced by the fact that 68 of 151 cases had a tem- 
perature of 104° F. or over, during- the first three days of 
observation; that 54 had a temperature of 104°by the second 



DIAGNOSIS. 231 

day ; that 34 had a temperature of 104° F. or over on the 
day on which they came under observation, 13 of these cases 
had a temperature of 105° F. or over, and five had a tem- 
perature of 106° F. when first seen. Of this 151 cases, 
44 were at the fastigium when they came under observation, 
and the temperature rarely went so high again during the 
disease; 29 other cases registered highest on the second day 
of treatment ; 18 on the third day ; 16 on the fourth day; 1 1 
on the fifth day; 13 on the sixth day; 6 on the seventh 
day; 2 on the eighth day, and 1 on the ninth day of treat- 
ment. 

The temperature in these cases reached normal in the 
following order; 4 on the fifth day; 9 on the sixth day ; 10 
on the seventh day; 9 on the eighth day; 21 on the ninth 
day; 19 on the tenth day; 16 on the eleventh day; 9 on 
the twelfth day; 15 on the thirteenth day; 9 on the four- 
teenth day; 4 on the fifteenth day; 3 on the sixteenth day; 
7 on the seventeenth day; 1 on the eighteenth day; 3 on the 
nineteenth day; 2 on the twentieth, and one each on the 
twenty-first, twenty-second, twenty-third, twenty-fifth, thirty- 
first, and thirty-second days. 

Of the 229 cases reported by Dr. Osier, "there were 
152 cases, 66.3 per cent in which at some time during the 
disease the thermometer registered 104° and over. Eight 
cases only had a temperature above 106° F., in one the reg- 
ister was 107°. Fifty-nine cases had a temperature between 
105° and 106°; and eighty-five cases had a temperature be- 
tween 104° and 105°. Of the 85 cases with a temperature 
between 104° and 105° there were 7 deaths, 8.2 per cent. In 
the 59 cases with a temperature between 105° and 106° there 
were 10 deaths, 16.9 per cent and of the 8 cases with a tem- 
perature above 106° there were 4 deaths, 50 percent. There 
was only one fatal case with a temperature below 104°, a man 



232 DIAGNOSIS. 

aged seventy, who was admitted in a state of extreme 
debility, with consolidation of the lower left lobe, and 
the case was regarded as one of pneumonia. " 

While as we have seen a rapid and early elevation 
of temperature is not inconsistent with a diagnosis of 
typhoid fever, neither is a lower temperature than Wun- 
derlich claims essential to such a diagnosis, negatively 
pathognomonic of that disease. 

It is possible for a patient to have typhoid fever 
with a temperature registering at all times below 101°, 
indeed a patient may, with such a temperature have ex- 
tensive ulceration of Peyer's glands, accompanied by co- 
pious intestinal haemorrhage. Enormous rises in tem- 
perature sometimes occur in late stages of typhoid fever 
apparently from the most trivial causes. I have known 
an elevation of four or five degrees which was occasioned 
by some slight indiscretion in diet, when the intestinal 
lesions were severe, and of three or four degrees when I 
was quite satisfied that there were no severe intestinal 
lesions, the disease having been so effectually aborted as 
to prevent necrosis of the glands. One patient, a giddy 
girl, who persistently gratified a morbid appetite, had a 
rise of temperature of five degrees from eating two or 
three pickled cucumbers, and on a later occasion it was 
elevated two degrees from a supper of pickled pigs feet. 

It is often impossible to take the temperature accu- 
rately in the mouth, and the failure to do so, has been 
the source of grave errors in diagnosis, and might lead 
to an erroneous prognosis or evun injudicious advice as 
to diet and treatment. I therefore advise when no in- 
surmountable obstacles exist, that the temperature be 
taken in the rectum, where 99° F. will represent a normal 
temperature. 



DIAGNOSIS. 033 

It must be understood, that the exceptional tempera- 
tures noted are exceedingly rare, and that they do not 
greatly impair the value of this symptom as a diagnostic 
sign. 

We may still regard an elevation of temperature with 
some of the characteristics of the Wunderlich curve, as 
the most constant and one of the most characteristic of 
all of the symptoms of the disease. I have never seen 
a case of typhoid fever, in which there was not a well- 
marked elevation of temperature with decided remissions. 

Meteorism. — Tympanitis is a symptom of much diag- 
nostic value. It was present in some degree in 463 out 
of 654 cases reported by various observers. These re- 
ports do not include my own recorded test cases, in 93 
per cent of which it was present. By the extent of the 
tympanitic distention is given some indication of the 
gravity of the patient's condition. 

Abdominal Tenderness and Pain. — These are 
amongst the most characteristic symptoms of typhoid 
fever. My experience is that by the eighth day, and 
usually much earlier, pressure deep into the right iliac 
fossa will rarely fail to elicit some expression of pain. 
Sometimes patients will shrink from the lightest touch, 
while others will complain of but a slight soreness under 
firm pressure. When pain is complained of, it is some 
times referred to this region, sometimes to the neighbor- 
hood of the umbilicus, and sometimes it is general over 
the abdomen. 

Gurgling. — Under palpation in the right iliac 
region is present in a large majority of cases, but is com- 
mon to too many other diseases to be regarded as of 
great diagnostic value. 



234 DIAGNOSIS. 

Enlargemement of the Spleen. — : This symptom 
is generally, if not always present. It is greatest toward 
the end of the second week of the disease, and has almost 
if not entirely disappeared by the end of the fourth week. 
The enlargement is also greatest in young subjects. 

Diarrhcea. — Usually of ochre colored stools, some- 
times containing sloughs of Peyer's glands, shreds of 
membrane, particles of undigested food, and blood, is 
present at some stage of the disease in a large majority 
of cases ; it was present to some extent in 347 of 442 
cases examined for this symptom by several observers. 
The stools are alkaline instead of acid as in health. Triple 
phosphates frequently found and formerly supposed to be 
peculiar to typhoid fever, are common to other diseases 
in which the stools decompose rapidly. A careful micro- 
scopical study of the dejecta might verify the diagnosis 
in doubtful cases. 

Urine. — The discovery by Ehrlich of the Diazo 
test, has added greatly to the importance of the urine 
as an aid to the diagnosis of typhoid fever. The ex- 
cretion of the kidney is. especially in the earlier stages 
of the disease, scanty, dark colored, of high specific 
gravity, of offensive odor, and of excessive acidity (on 
account of diminution in quantity). It is hypertoxic, 
maintaining the latter quality sometimes for weeks after 
convalescence is well established. Although the Diazo 
reaction is not pathognomonic of typhoid fever, nor its 
absence conclusive negative evidence, it undoubtedly 
possesses some diagnostic value. It has been largely 
used and much discussion has taken place as to its im- 
portance, but its exact import must be determined by 
future investigations. It merits a place here. 



DIAGNOSIS. 035 

Ehrlich's Diazo Test. — Made by adding to 1 
volume of urine, 1 volume of the test solution which is 
composed of - 1. c. c. of b. (b = sodium nitrite 0.5 dis- 
tilled water 100) added to 40 c. c. of a (a = sulphanilic 
acid 5.0, hydrochloric acid 50 c. c, distilled water 
1000.0). Add sufficient ammonia to render the solution 
alkaline, allowing" the latter to flow down the side of the 
tube. Shake to produce a foam, which should be rose- 
red overlying a ring of orange red. 

The microscope may prove a valuable aid to diag- 
nosis, since the Koch-Eberth bacillus can be found in 
the urine in a very large percentage of cases of typhoid 
fever, and when found are, when supported by other 
symptoms, pathognomonic of that disease. 

Large numbers of foreign and a few American ob- 
servers (notably at the Johns Hopkins Hospital) have 
devoted much time and study to the urine and to renal 
complications and the literature on the subject is exten- 
sive indeed, but I have not referred to it regarding 
any such reference as a waste of time, since the fact 
that all of these studies have been made under mis 
taken notions as to treatment and in ignorance of tin- 
fact that the disease can be aborted, and that under 
abortive treatment the renal complication so carefull) 
studied and so verbosely described, will rarely or 
never occur and hence this literature will all have to 
be rewritten. When the malady is properly treated, 
the urine rapidly loses its disagreeable odor, its high 
specific gravity and becomes clear and normal in quan 
tity and quality. 

Intestinal Hemorrhage.— With the exercise oi 
ordinary care to exclude haemorrhage from di 
able extraneous causes, this symptom is practically 



236 DIAGNOSIS. 

pathognomonic of typhoid fever. Although it may oc- 
casionally be due to the congestion of the capillaries, 
when it occurs before the twelfth day, and in insig- 
nificant amounts ; and in this instance it may be con- 
sidered beneficial. It is generally caused by the ul- 
ceration of Peyer's glands, and is directly due to the 
extension of an ulcer through the walls of an artery. 
When it occurs after the twelfth day, it is alv/ays an 
alarming symptom and ominous in proportion to the 
quantity of blood which is lost — not the quantity es- 
caping from the bowel — for fatal haemorrhage may 
supervene and yet no blood be passed. Too much 
confidence must not be placed upon the time in the 
course of the disease, at which the haemorrhage occurs, 
because, no matter how early it happens, it may always 
be due to ulceration, and though small in quantity, it 
may be but the earnest of that which will come later, and 
close the scene. It cannot be doubted but in exceptional 
instances ulcerations of Peyer's glands have been ob- 
served in cases which have ended fatally during the 
first week of the disease. 

Murchison says: ''There are several cases on 
record where ulceration has been found as early as the 
ninth or tenth day, but it may commence on the sev- 
enth day." Cases have already been referred to in which 
the ulceration has advanced to perforation on the eighth 
or ninth day. " Stoll relates a case where extensive 
sloughs were found in the ileum as early as the seventh 
day," and Boudet has published minute particulars of 
a case, fatal at the end of five and one-half days, in 
which deep ulcers, with partially detached sloughs, 
were found in the bowel. There is reason to believe 
that in rare cases ulceration may commence on the 



DIAGNOSIS. 0-7 

first or second day. The intensity of the morbid pro- 
cesses may, and no doubt does, in some degree at least 
determine the date as well as the extensiveness of the ul- 
ceration. The following rough outlines will give an 
illustration of the course usually pursued by a typical 
case of ordinary severity. During the first eight days of 
the disease, Peyer's glands, solitary or agminated or 
both, become infiltrated with the poison of the fever, 
enlarged by the proliferation of the cellular tissues and 
highly inflamed (the bacillus typhosis has been found 
deeply imbedded in its structure, as well as in that of the 
mesenteric glands, the spleen, the liver, kidneys and 
other organs). On the eighth or ninth day these glands 
present smooth, soft, elevated, noneroded excrescences, 
extending two or three lines above the mucous surface 
of the intestine. They are pink or rose colored, but 
there is no evidence that the enlargement is preceded 
by a stage of congestion. Hence a mere congestion 
of the bowel after death, without tumefaction of IV \ 
glands, is not evidence of typhoid fever. Moreover, the 
glands may regain their normal state by resolution at 
any stage prior to necrosis. This is effected, as in Other 
inflammations, by diminution of the vascularity. About 
the tenth or eleventh day the tumefied glands become a 
little more indurated. On the eleventh or twelfth day 
the mucous membrane covering the gland is softened 
and eroded. From the thirteenth to the fifteenth day tin- 
gland itself becomes necrosed. From the fifteenth to 
the seventeenth day the sloughs separate, leaving ul 
of varying depth, surrounded by swollen and inflamed 
margins G f mucous membrane. Cicatrization may be 
long delayed, but should commence by tin- twentieth or 



238 DIAGNOSIS. 

the twenty-first, and be completed by the fortieth day or 
a little earlier. 

Headache — Is one of the most valuable diagnostic 
signs of typhoid fever, being one of the earliest as well 
as one of the most constant symptoms of the disease. 
Murchison says that it was present in 77 out of 82 of 
his cases. Louis noted its presence in all but 7 cases 
of 133 cases. Of 126 cases in which Louis noted 
its date of commencement, it existed from the first in 
112, and in all of the remaining 14 it began on or before 
the sixth day. It was present in 97 out of 101 of my 
cases and was the first symptom complained of in a large 
majority of them. It may be frontal, occipital or a 
general cephalalgia. 

Murchison says: "It is usually confined to the 
front of the head. It is almost always a dull, heavy, 
persistent headache, which ends toward the close of the 
second week." 

Closely allied to the foregoing symptom, is the pain 
of the back and limbs, which is usually described by the 
patients themselves as " aching of the bones." Like the 
headache it is often present from the very onset of the 
disease. 

Vertigo is also an early and tolerably constant 
symptom, and is sometimes the one of which patients 
make the most bitter complaints. One patient told me 
on my first visit, that she was so dizzy that she could not 
sleep; that she was afraid of falling out of bed, and re- 
peated this at every opportunity, until her temperature 
was nearly normal. 

Epistaxis is in my experience a very common symp- 
tom, and a valuable aid to diagnosis. I inquire about it 
in all doubtful cases, and its absence would lead me to 



DIAGNOSIS. 39 

scrutinize other symptoms more closely before accepting 
a diagnosis of typhoid fever. 

The general consensus of opinion of most of the 
modern writers on the subject, however, is that the symp- 
tom is far less frequent and consequently of less value as 
a diagnostic sign, than it appears to me to be. It usually 
occurs early, but is found at all stages of the disease ; it 
may amount to but a few drops of blood, or the flow may- 
be so copious as to prove fatal. Haemorrhage sufficient 
in quantity to cause alarm, or even to require the plug- 
ging of the posterior and anterior nares is not very un- 
common. 

Pulse. — The condition of the pulse is of value, as an 
aid to early diagnosis, or rather as a warning to the phy- 
sician to look for other symptoms which may be suspicious. 
It is as a rule accelerated, but its increase in rapidity, 
although accompanying the elevation of the temperature, 
is not always in due proportion to the pyrexia. It is 
possible for a case of typhoid fever, with a temperature of 
106° F., accompanied with delirium, to have a pulse rate 
always below 90. One such instance has come within 
my knowledge during the past few weeks. A patient may 
have a pulse rate throughout the entire course of the dis- 
ease but little above normal, and it may also be so rapid 
as to be out of all proportion to the temperature, even 
when that is extraordinarily high. It varies greatly in dif- 
ferent patients and also in the same patient at (lit 
ferent times of the day or stages of the disease. It is 
usually strong and beats with considerable force in the 
earlier stages, but as the disease progresses, it grows 
weaker and more compressible ; beats more rapidly and 
often increases in frequency as the temperature drops. 
An irregular intermittent or imperceptible pulse, Of a 



240 DIAGNOSIS. 

pulse rate continuously above 120, is always an indica- 
tion of danger, and a low pulse rate is sometimes fol- 
lowed by immediate death. Murchison says he has 
known cases to prove fatal, in which the pulse never 
reached 100 ; and in eight of Louis' fatal cases the pulse 
never exceeded 90. 

Tongue. — The appearance of the tongue is usually 
characteristic in typhoid fever. When the patient re- 
alizes that he is ill enough to consult a doctor, the tongue 
will give assistance in making a diagnosis, if this disease 
be present. A moist tongue, covered with thin white fur, 
the margins and tip usually red, the latter often present- 
ing, especially in infants, a triangular red space at the 
tip, is as characteristic of the early stages of typhoid 
fever as is the dry, brown and often cracked and fissured 
or the red glazed tongue of the second or the third week 
of the disease. 

The Respirations in the early stages of typhoid fever 
are not usually accelerated, when no lung complications 
are present ; in later stages, however, they become more 
frequent. Sometimes this frequency is out of all propor- 
tion to either the pulse or the temperature. 

Sordes. — In the typhoid stage, sordes accumulate 
on the teeth, and haemorrhage from the gum sometimes 
occurs. 

Heart. — In severe cases of typhoid fever the heart's 
action may become alarmingly weak, and since the intro- 
duction of the coal tar derivatives a few years ago, a 
large number of deaths from heart failure in typhoid 
fever have been reported. 

Vomiting — Nausea — Retching — are sometimes the 
earliest symptoms of typhoid fever, but being neither con- 
stant nor characteristic of this disease, they are more apt 



DIAGNOSIS. 241 

to lead to an erroneous diagnosis of a "bilious attack," 
or some minor ailment, than to direct the physician's 
attention to the real disease. 

Hebetude. — Is a symptom of considerable signifi- 
cance, and is present in some degree in a very large ma- 
jority of cases. 

Delirium. — The delirium of typhoid fever is not 
usually present until the end of the second or the beginning 
of the third week, but sometimes it is very profound on the 
second or third, or even from the first day of the disease. 
It begins in almost every instance with a slight aberration 
of mind on first awakening; it sometimes increases to the 
wildest raving, and often is a prominent symptom until the 
temperature is normal; or it may merge into a deep stupor, 
coma and death. I have known of an instance in which a 
patient who escaped from the hospital while delirious, wan - 
dered miles away, without clothing, on rather a cold night, 
was arrested by the police, lodged in the station, returned 
to the hospital, and after all this exposure made a good and 
rapid recovery. 

Diagnosis.— While the series of pathologic changes 
which we designate typhoid fever, are primarily all due to 
the presence in the system of a single noxa, described by 
bacteriologists under the appellation of bacillus typhosis, 
there is no other acute disease so insidious in its attacks, 
so deceptive in its course, so varied in the forms in which it 
presents itself — which is accompanied by so many grave 
complications — is followed by so many dangerous sequelae 
— or is so often mistaken for other diseases, and in which 
these errors of diagnosis are followed by such direful mis- 
fortunes. 

The great variety of forms assumed by typhoid fe 
together with the fact that all of the prodromic symptoms, 



242 DIAGNOSIS. 

and indeed many of those of the fully developed attack, are 
common to many other pathological conditions, make this 
disease one of the most difficult, and again one of the most 
easily diagnosticated diseases. 

When all of its manifestations are typical and regular, 
the tyro may recognize it with perfect ease, while in some 
of its atypical forms, a diagnosis by the direct method pre- 
sents insurmountable obstacles even to the nicest diagnos- 
tician. A diagnosis is possible then only by reasoning by 
exclusion. It is, therefore, a differential diagnosis between 
typhoid fever and every other disease for which it (typhoid 
fever) could be mistaken. The other disease presenting 
usually more positive symptoms, can almost always be 
recognized much sooner than can typhoid fever. This of 
course requires an intimate knowledge of the symp- 
tomatology of a large number of maladies, a few of the 
most important of which are given here. When typhoid 
fever is present and not recognized, it is far more frequently 
mistaken for malarial fever than for any other ailment. A 
most fatal blunder — which the discovery of immortal 
Laveran, verified and supplemented by Golgi, Marchi fava, 
Celli, Bignami, Mannaberg, and many others, has rendered 
wholly inexcusable. Familiarity with all of the varied 
forms and stages of development of the parasites of malaria 
and a sufficiently accurate knowledge of the technique of 
the subject, to enable one to distinguish all phases of ma- 
larial disease by a microscopic examination of the blood is 
of course too much to expect of the busy general practi- 
tioner, but the recognition of the presence of the parasite is 
so easy that any physician ought to be able to at once 
exclude malarial fever from the patient's possible ailments 
when that disease is not present. The hematazoa in the 
red blood disk, or even the pigment globules in the leu- 



DIAGNOSIS. 243 

oocytes, in any of the varied forms are pathognomonic of 
malarial disease, and although not negatively pathogno- 
monic of typhoid fever, are strongly presumptive evidence 
that the latter malady is not present, since it is rare that 
the two diseases coexist in the same patient at the same 
time. 

. The importance of differentiating between typhoid and 
malarial fevers in the early stages, and the elimination 
from future discussion of the "vexed question" of 
" typho-malarial fever " is so great that too much space in 
this book cannot be accorded to the subject. I therefore 
quote from " Paludism" by Laveran — ■" the Parasites of 
Malarial Fevers " by Marchiafava and Bignami, and " The 
Malarial Parasites " by Mannaberg, which have been 
republished in English by the New Sydenham Society, 
as well as from the valuable article from the London 
Lancet of the sixth of July, 1895, by Dr. George Thin. 

Laveran says: "The parasite of palustral blood 
is seen under rather varied forms, which may be classed 
under the four following types : 

1st. Spherical bodies. 

2d. Flagella. 

3d. Crescent shaped bodies. 

4th. Segmented bodies and rose shaped bodi< 

The bodies which most interest the diagnostician 
whose object it is to differentiate between typhoid fever 
and malarial diseases are the spherical bodies, since he 
sees them far more frequently than all others combined. 
Laveran saw them in 389 of 432 cases. 

While observers generally agree thatthe amoeba in 
the stages of sporulation may not in all mild ca s< i be 
found in the blood from the finger tip, and that in mild 
cases they may not always be found in blood from the 



244 DIAGNOSIS. 

spleen at the outset of the disease or during the rise of 
temperature — this does not greatly diminish their value 
for differentiating between typhoid and malarial fevers, 
because although the means of making an exact diag- 
nosis of any one particular form of malarial disease may 
be wanting, there will almost invariably be present some 
form of the parasite of malaria, quite sufficient to indicate 
the nature of the disease, if not its class or stage, and it 
may be stated that the finding in the blood of a single 
malarial parasite is absolutely apodeictic evidence of 
malarial infection. These parasites of paludism are so 
easily recognized that any one having seen them once 
would be able to make a diagnosis of malaria, without 
any reference whatsoever to the text. Added to this the 
knowledge that many varieties in fresh blood declare 
their nature by their movements, amoebic, of the flagella, 
or of the pigment, and that they fasten themselves to the 
red blood disk and grow and increase in size, at the ex- 
pense of the haemoglobin and an error of diagnosis 
would be very unlikely to occur. 

These facts seem to be well established — that the 
paroxysms of malarial fever are coincident with the ar- 
riving at maturity of a generation of parasites — that cer- 
tain forms of the disease are caused by special parasites 
and that the periods of time intervening between the 
paroxysms of a given attack of malaria, correspond ex- 
actly with the life cycle of its parasite. Thus a quotid- 
ian ague is dependent on an amoeba whose cycle of 
evolution is completed in one day — the tertian in two and 
the quartan in three days. Irregular forms of malarial 
disease may be variously accounted for, as for instance 
by the presence in the organism of two generations of 
one parasite or the presence of different varieties of the 



DIAGNOSIS. 245 

parasites, but I believe that all malarial infections are 
dependent on some form of Laveran's parasite or on the 
retrograde metamorphosis of their noxious products. 

The technique of the microscopical examination of blood 
presents some difficulties, but the great and rapidly increas- 
ing importance of the subject demands that every physician 
should surmount them. The appliances for the purpose are 
not numerous or very expensive. An apochromatic oil im- 
mersion objective capable of magnifying 1,000 diameters, a 
series of good eyepieces, a good steady stand, and an 
apochromatic condenser, constitute the only costly essentials 
necessary for making a microscopical diagnosis of malarial 
disease. The lobe of the ear or bulb of the finger should be 
thoroughly cleansed before being pricked with a narrow lan- 
cet, to secure the small drop of blood for examination. This 
should be compressed between thin cover glasses and be ex- 
amined fresh or stained and allowed to dry. 

Dr. George Thin suggests the use of a mixture of two 
dyes and recommends Chezynsky's formulae as the best for 
general purposes, " which is made by mixing }4 percent 
solution of eosin in 70 per cent alcohol, 20 parts; concen- 
trated solution of methylene blue in distilled water, 40 parts; 
water 40 parts." In preparing this mixture I think the pre- 
cise strength of the alcohol is of importance.* 

For "concentrated" solution of methylene blue it would 
be more precise to write " saturated" solution. I have found 
the results more satisfactory by taking care that the solution 
of blue was really saturated. Some of this solution is filtered 
into a watch glass, and the cover glass with the blood sur- 
face downward is floated on the fluid. The length of time 

*Seventy per cent alcohol is made from methylated alcohol, which 
free from naphtha, by diluting 100 measures to 121 ; from I 
(0.793) by adding 31 ^ volumes of water to 10(1 volumes of the ftl< ohol In work- 
ing in analine dyes it is best tQ avoid the use of methylated alcohol. 



246 DIAGNOSIS. 

which should be allowed for the staining is, I think, generally 
understated, and depends on the temperature. I generally 
use an incubator with a temperature of about 98° F., and at 
this heat a quarter of an hour to about twenty minutes amply 
suffices ; at room temperature half an hour to two hours may 
be found necessary, according to the time of the year. If 
the preparation is an important one, it is advisable to watch 
the staining process by washing off the dye occasionally with 
distilled water and looking at it unmounted with a low 
power, putting it back in the dye if necessary, until the req- 
uisite degree of staining is obtained. When this has been 
found the cover glass is washed in distilled water and al- 
lowed to thoroughly dry, and is then mounted as a dry prep- 
ration, being kept in position on the slide by a margin of 
melted paraffin, brushed around it. It may be examined 
at once or after a period of weeks. After a little practice, 
the parasites can be easily picked out in such preparations 
with a very low power. For this purpose I use successfully 
a low power objective with Powell and Lealand's No. 10 
compensating eyepiece. This gives me a very large, clear 
field, the magnifying power being 210 diameters, and the 
blue stained parasite stands out distinctly and boldly 
(although a very minute object) in the red corpuscle. 
When a parasite has been found it may be examined by a 
high power objective, an j4 or higher, when the pigment, 
if present, should be seen more or less distinctly according 
to its fineness and distribution; but for the satisfactory ex- 
amination, particularly as regards the stage of development 
of the parasite and the distribution of the pigment granules, 
an oil immersion objective should be used. 

" For the size and form of the parasite and its relation to 
the red corpuscle, and for the presence and condition of the 
pigment, the use of methylene blue and eosin is sufficient. 



DIAGNOSIS. 047 

Eosin is particularly useful in showing the poverty in 
haemoglobin of the large, swollen, red corpuscle which 
harbors the tertian parasite. In order to render the 
detection of the parasite by this method easier to those 
who are beginning the work, I have thought it useful to 
show by definite outlines, drawn to scale, the size of the 
objects which have to be looked for, according to the 
magnifying power which is used. 

Although I recommend every observer to provide 
himself with apparatus which will give him a magnifica- 
tion of 1,000 diameters, it must happen to many to be 
obliged to use a lower power, at all events for a time. I 
have therefore made the drawings which are printed in 
the accompanying plate chiefly to two scales, one of 500 
and one of 1,000 diameters ; 500 diameters being with- 
in the reach of most, even of the commoner microscopes, 
if the highest system with which they are provided is of 
sufficient quality to bear a fairly high eyepiece. For 
the finer details of the structure of the parasite, more 
particularly of the spores, haematoxylin should be em- 
ployed. It is by the use of this dye that Mannaberg has 
made a distinct advance in our knowledge of this diffi- 
cult subject. The process which he recommends, al- 
though apparently somewhat complicated, is not difficult 
to carry out. "The dried preparation is floated for five 
minutes in distilled water, and after being dried with 
blotting paper is passed several times through a weak 
solution of acetic acid (a drop of acetic acid in 20 centi- 
meters of distilled water) until the haemoglobin dis- 
appears. The colorless preparation is then laid for two 
hours in the following fixing fluid: concentrated aque- 
ous solution of picric acid 30, distilled water 30, glacial 
acetic acid 1. From this mixture it is placed for .-mother 



248 DIAGNOSIS. 

two hours in absolute alcohol, and then placed from 
twelve to twenty-four hours in an alum haematoxylin 
solution. Differentiation of the stain is effected by 
using a % per cent hydrochloric acid alcohol (alcohol of 
75 per cent) and then ammoniated alcohol (3 drops of 
ammonia in 10 cubic centimeters of 75 per cent alcohol), 
which is washed in 80 per cent alcohol. The prepara- 
tion is mounted in Canada balsam dissolved in xylol. 
The process is a tedious one, and care must be taken 
regarding the strength of the hydrochloric acid alcohol. 
If the ammonia is used too strong, or for too long a 
period, it acts very destructively. Unless the prepara- 
tion is allowed to dry thoroughly before mounting in 
balsam, I recommend a stronger, say absolute, alcohol. 
Some of the most interesting appearances shown in 
Mannaberg's book, such as those in the plates 3 and 4, 
were obtained by this process, and these drawings can- 
not be neglected by any one who studies the structure 
and development of the parasite. Dr. Thin also says : 

" The utility of examining blood for the malaria par- 
asite in cases of fever is too evident to be enlarged 
upon, but its utility is much greater in some classes 
of cases than in others. It does not require a microscope 
to diagnose or treat successfully a case of classical ague, 
or even many of the cases of irregular and remittent 
fevers which are due to malaria, although microscopical 
observation is much more important in them than in 
tertian and quartan fevers. It is certain, however, that 
even in malarial countries many cases of fever are diag- 
nosed and treated by skilled and experienced observers 
as of a malarial nature, which are really due to other 
causes. There are cases in which a considerable time 
must elapse before the diagnosis can be made from the 



Fig.l 
a 



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"ig.2 




a 






1 

1 


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Q 




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Fig.+ 



a 



Fig.5 

b id 

* e c 



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Fig-6 



Fi^7 



Fig.8 Fig.9 







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Copied by permission of Dr. Geo. Thin from the London i I July 8 

Plate 4 



EXPLANATION OF PLATE IV. 

Fig. 1. A red blood corpuscle from fresh normal blood, drawn to scale by camera lucida, to form a standard 
for comparison with the figures of dried and stained blood which follow. (The color of the fresh blood is not 
reproduced), a, x 500 diameters ; b, X 1.000 diameters ; and c. x 2.000 diameters. (In this and the subsequent 
figures the objectives employed were, for the 500 diameters, a dry objective by Powell and Lealand ; for the 1,000 
diameters Powell and Lealand's apochromatic Jjth oil immersion with the No. 10 eyepiece, or the „y,h apochro- 
matic oil immersion of the same makers with a low eyepiece; for the 2,000 diameters the r J a th with No. 10 eye- 
piece). 

Fig. 2. Blood from a dried preparation stained in haematoxylin and mounted in glycerin ; chronic irregular 
fever ; sporulation in internal organs. The blood, which is from the finger, shows the red corpuscles being 
attacked by the parasite in its earliest stage. In one corpuscle two parasites are observed. The part chosen for 
drawing contained an unusual number of affected corpuscles, a, x 500 diameters ; and b, X 1,000 diameters. 

Fig. 3. A blood vessel from a section of a portion of brain given to me by Dr. Bignami from Prof. Marchia- 
fava's laboratory in Koine. The section which was cut in paraffin, was stained in haemalum and cochineal, a. 
A red corpuscle containing no parasite, b. A red corpuscle containing an eccentrically situated parasite ; c. A 
red corpuscle containing two parasites. The protoplasm of the parasite is stained a deep pink, the nuclear 
elements a very dark purple. (In this and similar preparations the resolution of the stained nuclear elements 
into separate minute spheres depends to a considerable extent on the excellence of the objective used. The 
darkly stained nuclear elements of the parasite as shown in this figure must not be confounded wilh pigment. 
No pigment was observed in the section, and the case was therefore probably one of quotidiana perniciosa 
caused by the pigmentless quotidian parasite described by Marchiafava and Bignami. 

Fig. 4. The crescent shaped form of the parasite found in the blood in irregular chronic fever. The dried 
blood from the finger was stained by haemalum in excess, and subsequently partially decolorized by weak hydro- 
chloric acid, a. The parasite with arc shaped line indicating the contour of the red corpuscle in which it had 
developed, b. Free parasite x 500 diameters, c and d, the same x 1,000 diameters, e. Red corpuscles in tlve 
same preparation x 1,000 diameters. 

Fig. 5. Crescent shaped parasites in the blood, sealed in solution of methyl green in 1 per cent acetic acid. 
The color of the methyl green is not shown in the plate, a. A crescent sealed in the solution, to which a little 
glycerin has bren added, b. A crescent in the solution without glycerin, drawn shortly after being sealed. 
Many crescents seen in this staining solution have the shortened, mutilated appearance shown by this one. The 
red corpuscles, which are much shrunk in size, are quite colorless, and are indicated only by very fine lines, 
much fainter than is shown in the drawing. The magnification in this figure was not accurately estimated, but 
that of a is about 700 to 800 diameters, and that of b nearly 1,000. The red corpuscles in b had shrunk more than 
those in a. c. A red corpuscle containing a round parasite with peripheral pigment from a case of irregular 
fever with the formation of crescent bodies, Sporulating forms were not found in blood from the finger. This 
drawing is shown under this figure because it is typical of forms that are found (in my experience, sparingly) in 
cases with crescent formation. The drawing was not to scale by camera lucida, but the magnification is slightly 
over 1,000 diameters ; eosin and methylene blue. 

Fig. 6. A red corpuscle containing the tertian parasite before the formation of pigment ; eosin and methy- 
lene blue ; the parasite is stained blue, x 1,000 diameters. 

Fig. 7. A red corpuscle containing the tertian parasite with the beginning of pigment formation and two 
normal red corpuscles beside it ; eosin and methylene blue. The larger size of the corpuscle which contains the 
parasite is to be noted, x 1,000 diameters. 

Fig. 8. A red corpuscle containing the parasite in a more advanced stage of pigment formation. Note the 
serrated appearance at one part of what remains of the red corpuscle, caused by the destructive action of the 
parasite, x 1.000 diameters ; eosin and methylene blue. 

Fig. 9. The tertian parasite with spore formation and central pigment. The number of spores is unusually 
small for the lertian parasite. Note the disappearance of the haemoglobin from the red corpuscle and its com- 
paratively large size as compared with the normal corpuscles around it. which appear to have been considerably 
shrunk by the drying process, X 1.000 diameters ; eosin and methylene blue. 

Fig. 10. a. A red corpuscle containing the tertian parasite with spore formation complete; haemalum and 
eosin. The nuclear element of each spore is stained by the haemalurn. x 1,000 diameters, b. The same x 
2,000 diameters. Note the contour of the perfectly colorless red corpuscle, and that in the parasite between 
the spore zone and the mass of central pigment there is a structureless substance less deeply stained than the 
spores. 

Fig. 11. The tertian parasite. A group of spores just separated from the corpuscle ; haemalum and eosin. 
The position of the central mass of pigment shows that the relative position of the spores has been comparatively 
little changed by drawing the one cover glass over the other in making the preparation. Each spore contains a 
distinct haemalum stained nuclear element, a. x 1,000 diameters, b. x 2,000 diameters. 

Fig. 12. Sporulating form of the quartan parasite stained by alkaline (Loefiier's) methylene blue. Sporu- 
lation is complete, with central pigment, a. x 500 diameters ; b. X 1,000 diameters ; c. x 2.000 diameters. 
Note in b and c that there is still a narrow rim of corpuscular substance preserved, that the spores are the usual 
number in this parasite (8), that the corpuscle which contains the parasite is hardly larger than the unaffected 
red corpuscles which surround it, and there is an absence of the zone between the spores and the pigment which 
is seen in the tertian parasite. 

Fig 13. a. Phagocyte white corpuscle containing small pigment spheres. The patient was suffering from 
chronic malaria acquired in Bombay. He was weak and anaemic, his spleen was slightly enlarged, and at con- 
siderable intervals he had slight fever lasting for a day at a time. I found no parasite in the blood from the 
finger, but several pigment bearing white corpuscles. The figure was drawn by camera lucida from a sealed 
preparation of fresh blood the day after it was prepared ; x 1.000 diameters, b. White corpuscle containing rod 
shaped blocks of pigment from blood preserved in Pacini's fluid, kindly sent me by Surgeon-Major Sharp from 
Sierra Leone. The patient was said to be suffering from ague, and when the blood was taken his temperature 
was 105° F. No parasites were found in the red corpuscles, but there was an unusual number of white corpus- 
cles heavily laden with pigment. (Not a camera lucida drawing, but magnifying power probably about 1,000 di- 
ameters.) c. Phagocyte white corpuscle from dried preparation of blood from a case of chronic irregular fever. 
There were crescents in the fresh blood. The dark outline on the left, which did not take on the eosin color so 
deeply as the rest of the corpuscle, contained minute spheres of pigment, and seemed to be formed by extremely 
minute powdery pigment; the particles of which were too small to draw, and is suggestive of a parasite, prob- 
ably a crescent, enclosed in the corpuscle ; eosin and methylene blue ; x 1.000 diameters, cl. A white corpuscle 
containing pigment spheres in a blood vessel in a material spleen. For the section from which it is taken I am 
indebted to Surgeon-Captain Duggan. who prepared it in the British Institute of Preventive Medicine ; x 1-000 
diameters. 



DIAGNOSIS. 249 

clinical symptoms alone. I conceive that it is very im- 
portant to use the microscope in cases of so-called ' fever 
from exposure to the sun,' and I am afraid that occa- 
sionally cases diagnosed and treated as sunstroke are 
examples of pernicious malaria with coma. In all doubt- 
ful cases' of fever, therefore, occurring in countries where, 
for example, the diagnosis may lie between typhoid 
fever and malaria, and ' sun fever,' the microscope should 
be used and it should also be employed for diagnostic 
purposes in many cases of coma with acute febrile symp- 
toms which might perhaps more naturally suggest sun- 
stroke." 

This short outline of the diagnosis of malarial dis- 
eases by the microscope will enable any intelligent phy- 
sician, possessed of a microscope, with a compensating 
eyepiece and an apochromatic immersion objective, 
magnifying about 1,000 diameters, and the essential 
accessories, and who has acquired the necessary tech- 
nique of their use, to differentiate at once between these 
diseases as a class and typhoid fever. This will effec- 
tually eliminate the commonest of all errors in diagnos- 
ticating typhoid fever, if the observations of the future 
sustain the hopes and predictions of the present ; for 
there are those who, unable to find the parasite or even 
the pigmented leucocytes, insist that they arc not 
always present even in fatal attacks of malarial fever, 
and they would bury Laveran, Golgi," Mannaberg and 
Thin, the discoverers and investigators in unhonored 
graves along with the plasmodire malarise. 

Typhus Fever. — Notwithstanding the fact that t\ 
phoid and typhus fevers have so often been confound 
the features which distinguish them are usually better 
defined than were those which distinguished the former 



250 DIAGNOSIS. 

disease from the continued forms of malarial diseases 
prior to Laveran's discovery. For while the bowels may 
be constipated in typhoid, and diarrhoea may be present 
in typhus fever, these occurrences are comparatively 
rare and in such instances some of the symptoms of the 
latter disease are apt to be prominent enough to guard 
the careful physician against the danger of making an 
erroneous diagnosis. If there be marked tenderness in 
the right iliac fossa, epistaxis, headache, etc., typhoid 
fever should be suspected even though the bowels were 
constipated. 

The slow insidious attack contrasted with the char- 
acteristically sudden onset of typhus fever; the remit- 
tent type of the fever ; the absence of early eruption ; 
the presence of meteorism — of intestinal haemorrhage — 
of the circumscribed pink flush seen in one or both 
cheeks in typhoid fever ; contrasted with the absence of 
these symptoms and with the general dusky hue of the 
skin and the congested conjunctivae of the victim of 
typhus fever; all make up a series of symptoms which 
should make it an easy matter to differentiate between 
the two diseases. The history of the source of the at- 
tack if known will aid the investigator in reaching a cor- 
rect conclusion. 

Further assistance will be obtained by noting " the 
principle points of distinction between the spots of en- 
teric fever and those of typhus " as given by Murchison. 

Enteric Fever. Typhus. 

1. Pink or rose colored 1. May be dirty pink or 
throughout. red at first but soon be- 

come reddish brown. 
2. Undergo no change 2. Become gradually 



DIAGNOSIS. 



251 



Enteric Fever. 

until they fade or disap- 
pear. Never converted 
into petechias. 

3. Circular. 

4. Isolated and few in 
number. 

5. No subcutaneous mot- 
tling. 

6. Elevated above the 
skin. 

7. Disappear on pressure, 
as long- as they last. 

8. Rarely appear before 
the seventh day. 

9. Appear in successive 
crops. 

10. Each spot lasts only 
three or four days. 

11. Never present on a 
dead body. 

12. A large number does 
not indicate danger. 



Typhus. 

darker, and are often con- 
verted into petechias. 

3. Of irregular form. 

4. Numerous and adhere 
in patches. 

5. Mottling common, in 
addition to spots. 

6. Not elevated, except 
at first appearance. 

7. Do not disappear on 
pressure, except at first. 

8. Appear on the fourth 
or fifth day. 

9. Never in successive 
crops. 

10. Many of the spots may 
last to the end of the 
fever. 

11. Often persist after 
death. 

12. Direct ratio between 
the number and dark 
ness of the spots and tin- 
severity of the disease. 

"It is important to determine whether the lenticular 
spots above described be ever present in other diseases 
than enteric fever. ... At the London Fever Hospital 
I have had occasion to examine many thousand cases ot 
acute disease of every form, and my opinion is that an 
eruption which presents all the characteristics above men- 
tioned is peculiar to enteric fever." 



252 DIAGNOSIS. 

Scarlatina. — Although a scarlet rash sometimes ac- 
companies early stages of typhoid fever, the two diseases 
should never be confounded. The sudden rise of tempera- 
ture in scarlet fever forms a marked contrast to the Gradual 
step like rise of typhoid fever. Moreover, there is rarely 
any sore throat in the latter disease, and its dryness should 
never be mistaken for the characteristic sore throat of 
scarlet fever. 

Puerperal Fever— Pyaemia. — When typhoid fever oc- 
curs in the puerperal state it is often mistaken for puerperal 
fever, and sometimes simulates that disease so closely that 
an exact diagnosis is exceedingly difficult. The presence 
of rose spots, epistaxis, step like rise of temperature, indi- 
cate the one, and the profuse sweating, the rigor and the 
absence of the foregoing symptoms, together with the cir- 
cumstances under which the attack comes on, may indicate 
the other. 

Tuberculosis. — The most perplexing diseases to differ- 
entiate from typhoid fever are the several forms of tuber- 
cular disease. 

Acute Phthisis Pulmonalis. — Since the fever in this 
disease is sometimes remittent — the cheeks present the same 
circumscribed flushes — and other symptoms of typhoid fever, 
they may very easily be mistaken for each other. The 
clinical and family history, the tympanitis, the enlargement 
of the spleen, the rose spots or epistaxis — when these are 
present, will usually enable the careful diagnostician to 
avoid error. If these symptoms are not found, the particu- 
lar observance of the thermic line, an ophthalmoscopic 
examination of the eye for the evidence of tubercle in the 
choroid, or a microscopical examination of the sputa for 
the bacillus tuberculosis will give pathognomonic evidence 
if the disease be the latter malady; though this would not 



DIAGNOSIS. o*q 

be negatively pathognomonic of typhoid fever, as the tuber- 
cular affection might possibly be a sequel to it. 

The same remarks apply to miliary tuberculosis, to 
tubercular meningitis, etc. 

"La Grippe."— Since the invasion of this country by 
epidemic influenza, a few years ago, a very large number 
of cases of typhoid fever have been erroneously designated 
"la grippe;" not a very unnatural mistake — as typhoid fever 
when the onset is sudden and the nervous symptoms pre- 
dominate very closely simulates influenza. 

A correct differential diagnosis may generally be made 
by a careful observance of the thermic line, as well as by a 
careful examination of the abdomen, which although fre- 
quently distended, never presents the tenderness in the 
right iliac fossa, which according to my observation is one 
of the most constant symptoms of typhoid fever. If these 
symptoms fail to appear the distinction can invariably be 
made in a very few days, as the two diseases after the first 
onset usually run quite dissimilar courses. 

Variola and Varioloid. — Although typhoid fever is 
sometimes mistaken for either of these diseases, there is 
little excuse for such an error. The cause of the mistake 
being usually a profuse crop of rose spots. The difference, 
however, between the characteristic eruption of typhoid 
fever and the acuminated eruption of variola is so marked 
that the two should never be confounded. The latter is 
hard, elevated, and presents to the touch the sensation oi 
split peas underlying the skin, while the former, although 
slightly elevated, yields readily to and disappears under 
slight pressure. 

Pneumonia. — I know of no certain means of distinguish- 
ing clinically between a true pneumonia and pneumo- 
typhus. I have been called too often at the closing scene, 



254 DIAGNOSIS. 

after the supervention of a fatal intestinal haemorrhage — 
after a few days of illness from pneumonia — to attempt to 
describe symptoms which might be misleading, and would 
at best give no information which could benefit the patient. 
I can therefore advise but one course \— treat pneumonia 
as typhoid fever as long as any doubt exists as to the char- 
acter of the disease. 

"A Bilious Attack." — Typhoid fever is very frequently 
mistaken for an ordinary bilious attack — an error which 
may be easily avoided by careful observation of the thermic 
line, but like pneumonia, the initial treatment of the former 
should be the same as that for typhoid fever. 

Acute Mania. — When typhoid fever comes on sud- 
denly and nervous symptoms and delirium predominate, it 
is frequently mistaken for mania, insanity, meningitis and 
cerebro-spinal meningitis. In all of these instances the 
thermometer alone will give sufficient information upon 
which to base a correct diagnosis. 

While it is true that obscure and atypical attacks of 
typhoid fever are sometimes exceedingly difficult to di- 
agnosticate, it is also true that in its regular and typical 
forms, where several of its characteristic symptoms are 
present, it is one of the most easily recognized diseases. 
The careful diagnostician who has seen the patient from 
the outset of the disease will make his diagnosis and 
have his patient well on the road toward recovery, while 
he who strives for scientific accuracy rather than for the 
patient's good will be awaiting the development of pa- 
thognomic symptoms, which may come too late to avail 
any useful purpose, or may never come at all. 

Sometimes the earliest symptom which is presented 
is a slight but persistent headache — a scarcely noticea- 
ble mental hebetude — a loss or even an unnatural increase 



DIAGNOSIS. 055 

of appetite — a little diarrhoea — a little dizziness — ring- 
ing in the ears — epistaxis — weakness — chills or chilly 
sensations — the diluted chills of Alonzo Clark — pain in the 
back and limbs — the bowels may be constipated or there 
may be mild or copious diarrhoea. The temperature 
maybe little above normal, the pulse sluggish or slightly 
accelerated. 

The presence of one or more of these symptoms 
should put the physician on the qui vive, for at this time, 
if never after, the patient may be cured — the disease 
aborted. The symptoms may now become more pro- 
nounced, insomnia supervenes, the temperature rises, 
usually by step like gradations and a degree or two each 
day, being from one-half to two or more degrees higher 
in the evening than in the morning. 

The period of highest elevation of temperature as 
also of greatest frequency of the pulse is about 8 
o'clock in the evening and both are nearest normal from 
7 to 9 o'clock in the morning. 

The symptoms generally increase in severity so very 
slowly that neither patient nor family realize the magni- 
tude of the mischief that is being done during the first 
week or two of the disease. It is unusual for the pa- 
tient to be confined to the bed and he may be able to 
attend to ordinary business or even perform hard man 
ual labor for six or eight days after he realizes that he is 
ill. Moreover it occasionally happens that the disease 
makes such slow and insidious inroads on the general 
health that before the patient feels sufficiently indispi 1 
to seek medical advice he has passed beyond the reach of 
medical aid. (See letters of Dr. Dodge for the repeat 
of a case in which the patient worked at hard manual 
labor, not knowing that he was sick until within a lew 



256 DIAGNOSIS. 

hours of his death as the result of perforation.) This 
case is one of great interest because he walked into the 
hospital one day, having- chopped wood in a lumber 
camp the previous day, and died on the following day, 
and the autopsy furnished the first positive proof of the 
character of the disease, several ulcerated Peyer's glands 
and a perforation in the center of one of them. A case of 
typhoid fever of moderate severity, running a typical 
course and coming under observation on the eighth day 
should present about the following conditions: range of 
pulse from 100 to 120, almost invariably accelerated toward 
evening, when the temperature should be 103.5° to 104.5° 
Fahrenheit, and a degree or two lower in the morn- 
ing, but both temperature and pulse vary greatly in 
the same patient; but while the latter is generally weak 
and compressible it is sometimes quite the reverse. 

The skin is hot and dry, especially in the afternoon 
and early part of the night. Although the bowels at the 
outset of the disease may have been, and more rarely 
may still remain constipated; there will usually be a 
more or less copious diarrhoea of ochre colored watery 
stools. This may however have been a precedent con- 
dition and there may be left only its history. There is 
complete anorexia and vomiting of a bilious character. 
The tongue presents a furred center and red margins and 
tip. The urine is scanty, high colored and strong; the 
abdomen is slightly distended and tympanitic ; palpation 
produces gurgling in the right iliac fossa; there should 
be slight tenderness also. Rose spots appear, fade away 
and reappear in successive generations. The headache, 
pain in the back and limbs give place about the middle of 
the second week to delirium, generally mild and at first 
appearing only at night, but gradually becoming wilder 



DIAGNOSIS. 237 

and lasting throughout the day. The splenic dullness, if 
previously observed, becomes more apparent ; sordes ac- 
cumulate on the teeth, and the tongue becomes dry and 
brown, and sometimes deeply fissured; the diarrhoea be- 
comes more profuse ; bed sores form over the bony prom- 
inences ; the pulse grows weaker and sometimes becomes 
dicrotic. Emaciation goes on to an alarming extent; 
low muttering delirium supervenes and intestinal haemor- 
rhage, perforation, peritonitis or coma and death may 
follow. 

Another equally typical case may present all, or a 
majority of these symptoms in a milder and modified form, 
may run its course to the middle or end of the second 
week, the patient being so little sick that no alarm what- 
ever is felt, but while lacking some of the elements of the 
danger of the preceding case, it is quite as liable to in- 
testinal haemorrhage or perforation and death, as is the 
sicker prototype. How frequently the daily bulletin has 
announced the patient " doing well" " progressing 
nicely" "temperature and pulse good" "feeling better 
to-day," until the friends are beguiled into false security 
from which they are rudely awakened "because! the 
symptoms have taken an unfavorable turn." 

Therefore every physician should remember that 
while cases, which at the outset present exceedingly 
severe symptoms sometimes recover, those which offer 
the mildest symptoms, not infrequently develop grave 
lesions when everything seems to be going smoothly and 
the patient seems to be reaching safe ground. It is safe 
to say that no matter how mild the symptoms, the 
typhoid fever patient is in serious danger from the time 
Peyer's glands have become inflamed until the la it ulcera 
tion is healed. If but one ulceration exists, and that 



258 DIAGNOSIS. 

ends in perforation — without surgical aid — death is practi- 
cally as certain as if all of the glands of the ileum were 
necrosed. 

A very large number of cases of typhoid fever never 
develop these fatal lesions or the " typhoid state" but 
it is far the most treacherous and fatal of all of those 
which we now recognize as preventable diseases. 

The results of the antiseptic treatment of typhoid 
fever when instituted at the outset of the disease have 
emphasized the importance of an early and exact diag- 
nosis, and ought to revolutionize the teachings of the 
medical colleges and text-books on this point. As long 
as the " expectant method" of treating the disease 
could be justified on the assumption that there was no 
better way — at least none that was feasible in private 
practice — it did not much matter when the diagnosis was 
made, so that it was gotten ready for the death certifi- 
cate—which is unfortunately not always done. 

Dr. James H. Hutchinson says : " In the doubt 
and obscurity which generally envelopes the diagnosis 
of the disease when the physician is first called upon to 
treat it, it is impossible to lay down any positive rules 
for the treatment of typhoid fever at its commence- 
ment." 

The author of the article on " Typhoid Fever in 
Pepper's System of Medicine " is not the only instructor 
or practitioner who has found it necessary to await the 
development of pathognomonic symptoms before for- 
mulating a course of treatment. This has long been, and 
is yet the usual custom. It would be impossible to con- 
ceive of a more pernicious and reprehensible practice, 
and yet it is exactly the course pursued by the dis- 
tinguished physicians who attended H. R. H. the Prince 
Consort of England so long ago. 



DIAGNOSIS. 259 

Typhoid fever has blighted many homes — has broken 
many hearts — and many sad chapters could be written 
on its history. What could be more heart rending and 
dolorous than the story of the far reaching misery and 
desolation resulting from the last illness and death of 
Queen Victoria's Royal Consort. 

I have dug up the history that I may most emphat- 
ically emphasize the importance of making an early 
diagnosis, and because the failure of those learned men — 
the flower of English Medicine — to make an exact diag- 
nosis until within eight or nine days of the death of their 
royal patient, was fraught with such direful results, and 
because this practice of yesterday conforms precisely 
with the course pursued by so many physicians of note 
to-day, in this land of progression, in these days of de- 
votion to bacteriology and sero-therapy ; indeed, it is 
the exception rather than the rule that a positive and 
exact diagnosis in typhoid fever is made early in the 
course of the disease or that any effective treatment is 
instituted in time to benefit the patient. 

The rational supposition would be that the cause 
of the illness of Prince Albert, this man so great and 
good, most dearly loved during life, most deeply mourned 
after death, practically the greatest ruler on earth ; 
with all the resources of the greatest and most enlight- 
ened nation at his disposal ; with all of the talent of the 
medical profession of the whole civilized world at his 
command, would be correctly diagnosticated at the 
earliest moment possible. "But he was so sick on the 12th 
of November, that the queen noticed it." Eleven days 
passed and on the 23d and again on the 2 Ith " his mind 
wandered strangely." " He was sleepless and his appe- 
tite was lost." On the 27th he went to see his son, the 



260 DIAGNOSIS. 

Prince of Wales, at Sandhurst, " who found him greatly 
out of sorts." '" On the 28th he was still worse." 

On the 1st of December Sir James Clark and Dr. 
Jenner " were disappointed at finding him so very mis- 
erable." On the second of December after a night of 
" shivering and sleeplessness" he sent for Dr. Jenner, 
who " found him suffering great discomfort and much 
depressed." " The symptoms of what might prove to 
be 'low fever' were beginning to be more marked," 
when the Prince heard of the death of his royal cousin, 
the King of Portugal and his brother, both of whom had 
died of typhoid fever at this time, he said he was 
glad that his disease " was not typhoid fever," because 
he knew he could not survive an attack. The Queen 
could not bring herself to believe that her husband was 
seriously ill, and on the 3d her opinion was confirmed 
by that of Sir James Clark, and on the fourth he still 
"consoled the Queen with smooth prognostications," 
and Dr. Jenner told her "the Prince must eat for he was 
simply starving to death/' On the 5th Sir James Clark 
" reported him somewhat better." Up to this time the 
prognosis given, and the fact that Dr. Jenner insisted 
that he must eat, very clearly indicates that the true 
character of his disease had not even been suspected. 
On the 6th of December the Queen's diary contains the 
following entry: "The doctors declared that they had 
all along been watching the patient's state suspecting 
fever, but unable to judge what it might be or how to 
treat him until that morning . . . that the fever 
must have its course, viz., a month . . . that he 
was not alarmed — that there were no bad symptoms, 
but he could not be better till the fever left him." . . . 
"They thought him less well and feverish," " the char- 



DIAGNOSIS, 261 

acter of the disease was now clear beyond a doubt, and 
the examination revealed physical signs that it was gas- 
tric or ' low fever.' " 

Martin says : ''Above all things the Prince seems 
to have had no doctor attending him who was capable of 
recognizing the gravity of the disease in time." Sir 
James Clark, Dr. Jenner, Dr. (later Sir Thomas) Wat- 
son, Sir Henry Holland and Dr. Brown, of Windsor — 
these learned and distinguished gentlemen were not 
more likely to blunder than the best of their confreres 
of that day (or for that matter of the present) and 
this narrative of the last illness of this royal Prince, 
"who, in the prime of manhood and full career of his 
usefulness, was removed by death," sounds much like 
the accounts of many cases treated very recently. In- 
deed the mode of procedure can hardly be said to 
have done injustice to the teaching or the practice 
of the present day. 

For a failure to make a diagnosis of typhoid fever in 
time to be of the slightest benefit to the patient is far more 
common than one who had not made a study of the subject 
would believe. This same course was pursued and with 
like results so frequently about this time as to throw nearly 
every Court in Europe into mourning deep and doleful. It 
was repeated ten years later in the case of the Prince of 
Wales, who however happily did not die. 

A repetition was seen last year in our own capital, when 
the Chairman of the Ways and Means Committee! at the 
time the most prominent political figure in the United 
States, stood up in the halls of Congress, speaking day 
after day, when he was really on the brink of the gra 
which he barely escaped. About the same time the wife 
of the President of the French Republic, the head of a 



262 DIAGNOSIS. 

noble English house, and many others whose rank and 
condition were evidence of their ability to command the 
best professional advice, were dying-, or lying very low, the 
prey to errors of diagnosis or treatment. 

Dr. Eliot, of New Haven, says: " Let me remind you 
that a little less than nine years ago, Frederic Mahomed, 
one of the assistants of Guy's Hospital, London, died at 
the age of thirty-five years, of enteric fever, and that a few 
days before his death, while his temperature was 104°, he 
left his residence and went to the hospital to see a student 
ill with rheumatic fever." His death " may serve to em- 
phasize a point of the very greatest importance in this con- 
nection ; it is the necessity of making a very early diagno- 
sis if one wishes to treat enteric fever with the best results. 
If the brilliant young assistant physician of Guy's Hospital 
had realized that he had this disease he would probably 
have remained in bed, and very likely would have recov- 
ered, to continue his investigations in cardiac and renal 
pathology." 

In alluding to one of the fatal cases, Osier, the oracle, 
says : " We did not really appreciate that he had typhoid 
fever during the first week in hospital. The temperature 
chart was very deceptive, and we thought it might be an 
anomalous form of malaria ; but repeated examinations of 
the blood were negative. After the enlargement of the 
spleen and the appearance of a few rose spots rendered 
certain the diagnosis of typhoid fever, the temperature did 
not rise above 102° until the thirteenth day in hospital. 
. . . . He took in all 114 baths. Death occurred from 
perforation on the fifty-first day. " 

While I am writing, hundreds are lying in the " valley 
of the shadow ofdeath," because, as the diary from which 
I have quoted says; "they seem to have no doctor 



DIAGNOSIS. 



263 



around them capable of recognizing in time the gravity" 
of the most fatal of all of the curable and preventable dis- 
eases. 

The reasons given in the extract from Pepper's 
"System of Medicine," for not specifying explicit rules for 
the treatment of the earliest stages of enteric fever, viz., 
the doubt and obscurity which generally envelopes the 
diagnosis of each case, when the physician is first called 
to treat the patient, are the very reasons why the diag- 
nosis should be made at once, and every doubtful case 
be regarded and treated as typhoid fever. 

Many if not quite all of the pathognomonic symptoms 
of typhoid fever are evidence of already existing anatom- 
ical lesions; they are consequently valueless as a guide 
to the physician, whose aim it is to abort the disease. 
Although he may be able to succeed occasionally after 
their supervention, in a malady of so insidious a char- 
acter as typhoid fever, it would always be unwise and it 
would sometimes be a fatal error to await their develop- 
ment. Therefore the physician who would avoid having 
a death from typhoid fever, must ever be on the alert 
lest the disease pass beyond his control. 

He should waste no time treating a case of this dis- 
ease for any of the milder ailments, and since the loss of 
hours in applying proper treatment for typhoid fever 
would sacrifice more human lives than would the loss 
of days in malarial fever, no physician should ever be 
guilty of the stupid and criminal blunder of treatin 
case of typhoid fever as malarial fever, a practice which 
cannot be justified by any course of reasoning. It de- 
prives the physician of the golden opportunity to abort the 
disease. It condemns the patient to a longer duration of 
illness. It places his life in jeopardy, and for what? The 



264 PROGNOSIS. 

credit to the physician of having made an absolutely cor- 
rect diagnosis. What does the patient care for the phy- 
sician's reputation, or what the disease is called, so long 
as he is cured of it in the shortest possible time and with 
the least discomfort and danger ? I am aware that the 
difficulty of making a correct positive diagnosis in atypi- 
cal forms of typhoid fever are sometimes insurmountable. 
In such cases as in all others the diagnosis for the pur- 
pose of treatment should be by the process known as 
''reasoning by exclusion " and when by this method all 
of the diseases from which the patient could not be suffer- 
ing have been eliminated, if typhoid fever be not among 
the excluded, the patient should be treated for that dis- 
ease. 

Prognosis. — In a very large majority of persons at- 
tacked by typhoid fever, the disease comes on so insid- 
iously, the patient during the first week perhaps scarce- 
ly realizing that he is sick, and during the second week 
growing worse so gradually that he, without awak- 
ing to the gravity of his condition, passes into a realm 
where he is incapable of caring or acting for himself, 
and as the friends notice only a slight change for the 
worse each day, they become accustomed to his state 
and usually fail to recognize the danger until aroused 
from their lethargy by the supervention of some grave 
condition which is intelligible to them. Under such 
circumstances the physician, because of the trust con- 
fided in him, is under a high moral obligation to warn 
the friends of the danger as soon as he recognizes the 
character of the disease, without awaiting the superven- 
tion of these alarming symptoms. 

The prognosis in typhoid fever should always be 
guardedly given. We have no certain means of finding 



PROGNOSIS. 265 

out how long" the patient has been indisposed or how ex- 
tensive or severe are the anatomical lesions ; death has 
occurred at all stages of the sickness and from perfora- 
tion and peritonitis within forty-eight hours of the time 
at which the patient first realized that he was ill, — from 
toxaemia at a period but a few hours later, from haemor- 
rhage on the eighth day, and extensive ulceration of 
Peyer's glands have been found in a patient who died 
on the seventh day. 

The usual course of the disease under abortive 
treatment has been clearly stated elsewhere, but if the 
physician gives a rose colored prognosis he should also 
explain the possibility of the occurrence of all of the 
numerous accidents which might befall the patient. 
He should keep 'his promises well within his power 
of performance, and to do so, he should know the history 
of the condition of the patient from the hour in which he 
felt the least invalidism. He should cross-examine the 
historian with the shrewdness and cunning of the pro- 
verbial lawyer, measure his intelligence and weigh his 
words, make his decision, and render his verdict, with 
the nicety of a supreme judge, to the end that he be not 
himself deceived as to the duration of the patient's ill- 
ness. He should examine the patient with great care, 
allowing no symptom to escape his observation and 
even then promise too little rather than too much. If the 
patient has been ill but a day or two, the disease will be 
easily and should be quickly aborted. If he has been 
ill four, five, six or seven days and the disease; is running 
an ordinary course, it can usually be aborted in from five 
to ten days, and the physician who has had large experi- 
ence with the abortive treatment will feel that he i i 
speaking within due bounds when he gives a progn 
in accordance with these facts. 



266 PROPHYLAXIS. 

Should the patient have been indisposed longer than 
the seventh day when first seen, no promise of speedy 
convalescence should be made. Hence it will be appar- 
ent that it will be from the general practitioner in private 
practice that must come the evidence that typhoid fever 
can be aborted, because the patients are usually beyond 
the reach of abortive medication when they are obliged 
to enter a hospital. 

Prophylaxis. — The conservation of the health of the 
people from the dangers of typhoid fever, as well as from 
those of many other diseases, is best secured by giving 
them an uncontaminated water supply. The fact that 
polluted water and typhoid fever occasionally holds the 
relationship of cause and effect has long been known, but 
the intimacy of their connection is not to this day fully 
recognized. While I am writing, there is appearing in 
successive issues of The Journal of the British Medical 
Association, a series of articles under the caption, 
" Water-borne Typhoid " from the pen of its distinguished 
editor, Mr. Ernest Hart, which are destined to do much 
good, by emphasizing the importance of pure water in the 
prevention of this disease. The author has collected and 
tabulated the principal facts of the occurrence of 206 out- 
breaks of this malady, in Great Britain and Ireland, which 
were disseminated directly or indirectly by water. All, 
with one exception, of the instances in which the water 
was the indirect cause of typhoid fever, were cases in 
which polluted water had been used to adulterate milk, 
or to rinse the cans. The one exception being that of a 
family, ten in number, all of whom had more .or less pro- 
longed attacks of enteric fever, which were the result of 
using the milk of a cow that had nothing to drink save 
"mere sewage." "The cases lingering on for months, 



PROPHYLAXIS. 2G7 

while the cow was herself getting thinner and thinner, at 
last refusing to graze. After she was got rid of the dis- 
ease disappeared from the house, but convalesence was 
tardy, though ultimately complete." "But during the 
tedious stages of the illness, one prominent feature was 
that of partial convalescence ' by fits and starts,' one day 
cheerfulness, another day lassitude, first playfulness, then 
a desire for rest." 

To strengthen my comments on this terrible con- 
dition of things I will quote Mr. Hart, who says: 

"My study of the subject dealt with in this report has 
led me very strongly to support the theory that sees in 
the soil the natural habitat and breeding ground of the 
bacillus of typhoid fever outside of the human body. This 
belief in nowise lessens my regard of the disease as being 
largely caused by water, rather the reverse." He further 
says: " Certain it is to my way of thinking that the es- 
sential element in the prevention of water-borne typhoid 
fever is cleanliness. All that go'es to cause pollution of 
the soil tends to foster the disease. No point is so 
strongly or so persistently brought in the history oi 
typhoid fever occurrences in our country as that dirt and 
disease go hand in hand. Only in the case of rivers, 
does man seem to place his excrement directly into his 
own or his neighbors drinking water, but he does not 
scruple in too many instances to so dispose of his filth 
that it must in the natural order of things find its way to 
that drinking water. It is not alone in our rural and 
sparsely populated districts that such disposal takes 
place ; it is just as common to see people harboring then- 
filth in proximity to dwellings and local water supplies in 
our towns. These abominations which to-day persist in 
so many of our towns — leaky and huge midden privies, 



268 PROPHYLAXIS. 

uncovered and ill constructed ash pits, cesspools per- 
mitting soakage of their contents, no one knows where — ■ 
all these and more are the accompaniments of daily life 
in scores of towns. And where town populations have 
the good sense to so dispose of their filth, as not poison 
the air they breathe or their local wells, too often we find 
them in their selfishness and negligence, endangering the 
water service of a vast aggregation of people in some ad- 
jacent city, or borough by so ridding themselves of their 
excrement as to pollute a gathering ground or stream, or 
river used for purposes of domestic water supply." 

One of the greatest dangers is the pollution of the 
wells in the suburbs of cities in our smaller towns and 
in the country, by outside privies or other like abomina- 
tions. In this connection I again quote the words of 
Dr. Hart, which are quite as applicable to these United 
States of America as to England. 

"Wells from a subsoil liable to pollution should in 
nowise be made use of as sources of water supply. 
The soil on which many of our towns are built has been 
subjected to gross contamination for many years, and it 
is not to be thought of as likely that the mere abolition 
of cesspools, and so forth, will at once render safe the 
abstraction of water from wells sunk in their proximity. 
. . . It is obvious, however, that many wells to-day in 
our country are not only so circumstanced as to seriously 
threaten the health of the consumers of their contents, 
but also that the wells are constructed in such a manner as 
to permit of soakage from surrounding soil into them, both 
surface and subsoil drainage. It should, therefore, be the 
aim of all sanitary bodies to secure the internal lining of 
wells being so finished as to prevent the ingress of water 
from any questionable source. . . The further danger 



PROPHYLAXIS. 



269 



of contamination of well water by reason of rain storms 
and resulting- floods is one to be thought of, and calls for 
the proper construction of well mouths, lest they be sub- 
jected to periodical overflow by surface water of polluted 
character." 

In regard to the use of the water from wells I shall 
quote a few remarks from "The Report on Typhoid 
Fever in the District of Columbia, submitted by the 
Medical Society of the District of Columbia to the Com- 
mittee of the United States House of Representatives." 

"The drinking of the infected water of wells has long- 
been known to be a mode of propagating typhoid fever. 
If the soil of the city is receiving a considerable amount 
of the excreta of typhoid cases — if much of that soil is 
badly drained and wet with returned sewage — is it possi- 
ble to avoid the danger of fouling the well water? It 
may be assumed that where there are the largest number 
of pumps there is the largest consumption of well w ater ; 
that well water is used most largely by the poor, and in 
those quarters of the city where the water and sewage 
connections are fewest ; the soil underlying the city is 
being constantly impregnated with human excrementi- 
tious matter, and with all micro-organisms therein con- 
tained, and that the water of wells liable to be contain 
inated with such material is being constantly and 
generally used as drinking water by the people. It is 
not a violent assumption that the well water thus con 
sumed is infected and dangerous to health. It is a mat 
ter of chemical and bacteriological demonstration. As 
sanitarians we must condemn the whole system and ad- 
vise an early abandonment of all wells as the only solu- 
tion of the question." 

The lesson of the experiences of Vienna should be 



970 PROPHYLAXIS. 

accorded some attention. " From 1851 to 1874 well 
water of an impure character was used to a large ex- 
tent. During this time the deaths from typhoid fever 
ranged from 10 to 34 annually in every 10,000 of the 
population. In 1874 spring water of great purity was in- 
troduced and the well water of impure wells given up. 
The annual mortality rate immediately fell to 5, and in 
three subsequent years to 1.1 per 10,000 of population. 
A good sewerage system was in existence long before 
this, but it had no effect in reducing the mortality, as 
sewerage without the abandonment of the drinking of 
infected well water is without effect." 

Mr. Hart in his superlatively excellent and inimitable 
report says : " What have the pages of my report 
shown ? They have shown typhoid fever caused and 
spread in a variety of ways by the agency of water ; 
they have testified to the fact that water can become 
polluted at its source, on its way to the consumer (alike 
before and after entry to the distributing mains), and 
within the precincts of the domestic dwelling. We have 
seen outbreaks caused by polluted wells, by sewage 
contaminated rivers and streams, by water services 
which have received the drainage of manured fields, the 
sewage of whole villages, and innumerable excremental 
pollutions over the areas of the gathering grounds ; by 
careless laying, in close proximity and in badly jointed 
fashion of water mains and sewers (the former even 
passing through the latter) ; by washing of milk cans 
with polluted water, by the mixing of milk with equally 
polluted water, and by numerous other ways." 

The time-honored practice of polluting our rivulets, 
creeks, rivers and lakes by pouring into them all excre- 
menta for equally civilized and refined human beings re- 



PROPHYLAXIS. 271 

siding further down their courses to drink will be re- 
garded by future generations with amazement and dis- 
gust, and fortunate indeed will it be for us, if in their 
charity they see any excuse or palliation for so criminal 
and barbarous a procedure. 

This great basin of the Mississippi Valley (bounded 
on the north by great inland seas ofpurest water, dotted 
all over with springs, veined everywhere by the ramifica- 
tions of streams, forming great rivers of water, every 
drop of which would be as pure and palatable as the 
"Fountain of the Virgin," were it not for man's filth 
which we have poured and still continue to pour into 
them) should and would be as free from typhoid fever as 
it is to-day from cholera. But this foul contamination 
has made the disease man's most dreaded enemy all over 
this princely realm. 

Typhoid fever prevails in the town in which I am now- 
writing, because the defilement and defcedation, the offal 
and carrion and fecula from the dunghills and quagmires 
and various other putrefying and festering sinks of cor- 
ruption in the two miles of the shore of the meandering 
little shallow river, whose waters creep sluggishly down 
to the intake at the water works, collecting on its way 
all that is reeking and stinking and vile along its banks, 
(above which are the homes of a dense population, with- 
out sewer connections), from the sewers and washings 
from the numerous towns in the valley above, and is 
then pumped into the water mains for 40,000 people to 

drink. 

Because of similar circumstances the city of Pitts- 
burg has at present many hundreds of cases of typhoid 
fever, with new cases reported at the rate oi t< n per 
diem. 



272 PROPHYLAXIS. 

These object lessons should teach the sanitary 
authorities the importance of so disposing of human ex- 
crementa that the inhabitants of the cities need not im- 
bibe in the water the noxa from the sewage from the 
cities, towns and the extensive country drained by the 
water courses in their vicinity. 

At this point I will quote what Mr. Hart says as to 
the remedy of the spread of typhoid fever. " I would 
suggest ridding the country of cesspools in the midst of 
towns, and would also see cesspit middens removed from 
off the face of the earth." 

And again he says "all midden privies and cesspools 
in towns should be abolished by law, feeling that these 
disease disseminating abominations, as we permit them 
to-day are annually costing the country enormous sums 
by these very qualities of disease provocation. To this 
end I would see that the statutory duty of sanitary 
authortiesto make provision for proper sewers* for their 
districts, enforced in all cases where sewage is practi- 
cable. . . . It will be necessary also, that the old disused 
forms of excrement disposal be done away with so as not 
to prove dangerous by reason of their condition at the. 
time of abolition. So I would see the application of 
some powerful disinfectant to the receptacles, when 
emptied finally, as well as of the complete filling, in of 
the space occupied by them, in such manner that no 
danger shall accrue to the water supplies by reason of 
future soakage of filth left in the middens, etc. ,, 

We should do all that our author suggests, but we 
should go much farther. No city, town or village should 
be allowed to pour her excrementa laden, poison bearing 

* Instead of sewers Mr. Hart should have written proper and efficient garbage 
crematories and sewers for drainage. 



PROPHYLAXIS. •);•: 

into any lake, river or stream. Pittsburg 
should not be required to drink the sewage of cities situ- 
ate above her in the valley, nor should she be allowed to 
thrust her corruption on the people of Cincinnati, and the 
hundreds of other cities and villages along the banks of 
the beautiful rivers. At the present time we may well 
say "distance lends enchantment to the view." Our 
water ways should not be converted into sewers convey- 
ing disease and death to the people. Each brooklet, and 
rill, and mountain torrent should gush, each lake, lagoon 
and estuary contain, and each aqueduct, conduit and 
canal overflow with pure and innoxious and potable water 
with which to supply man with a wholesome drink to 
quench his thirst, and in which to obtain wholesome fish 
for food, which we cannot take from impure water. The 
air wafted over their surfaces should be cool and sweet 
and salubrious, instead of the veritable tornadoes, reek- 
ing with the stench that now makes the vicinity of so 
many of them only places to be avoided. 

For all of the various ways in which water is polluted, 
some remedy must be found. Think of the conditions oi 
the cities, whose populations are now thoughtlessly 
drinkingwater polluted with human excreta, should chol 
era invade our shores, and yet typhoid fever is a little 
more slowly but just as surely destroying our people, 
and in the most disgusting way — for the presence of this 
disease is evidence that the patient has taken into his 
system a product of human excrement. Typhoid fever is 
a preventable malady. Is it not the plain duty of the 
Congress of the United States to adopt some measui 
arrest the wholesale pollution of the drinking water ol 
the country? 

The administration which rises above the petty affairs 



274 PROPHYLAXIS. 

which so often engage the attention of our Statesmen, 
— grasps the full import of this very important matter, and 
creates a new department of the Government of the 
United States — the Department of Public Health — will 
merit and receive the blessings of the people. 

It should be the first great duty of this " department " 
to prevent the occurrence of a disease which is known to 
be preventable, which has been practically abolished in 
some of the capitals of Europe, and when water and soil 
pollution have been arrested will be abolished every- 
where. If the causes of its persistence is known, if, 
above all, these causes can be removed — and they can — it 
is our part and duty to make the facts public and to arouse 
public attention to the necessity and urgency of the de- 
mand for action. 

A Secretary of Public Health on his induction into 
office, would find abundant occupation worthy of the most 
brilliant intellect, and demanding the highest executive 
ability, and not the least of his duties would be the pre- 
vention of water and soil pollution. Give all of the peo- 
ple of all of the land potable water, untainted with human 
excrement, and typhoid fever and cholera would be un- 
known. And only the strong arm of the general gov- 
ernment through a Secretary of Public Health can do 
this. But propose to the Congress of the United States 
the creation of such an office, and some cold, calculating 
member — some guardian of the treasury — forgetting all 
the grief and sorrow and suffering that these diseases 
cause, would ask if this secretary, which in the name of 
humanity we demand, could earn his salary. 

It is impossible to answer the question with all of its 
true force because we have no available statistics, as to 
the prevalence or mortality from typhoid fever outside 



PROPHYLAXIS. 075 

the larger cities, and the editor of the Journal of the 
American Medical Association, Dr. John B. Hamilton, 
whose knowledge of the distribution of diseases and of 
sanitary science is probably unexcelled says that typhoid 
fever is the bane of the rural districts, therefore the 
statistics of cities do not do full justice to the subject. 
In measuring the cost of an epidemic of typhoid fever, Dr. 
Osier says : " Cold lifeless things, figures make no more 
impression on the ordinary mind than would the enu- 
meration of the days of the year; not more also does the 
statement that at an estimate of an average of six weeks 
illness to each case, there have been from 1888 to 1892 
(inclusive) 82,512 weeks of lingering illness, about 1,600 
years. 

"When beneath untouched lintels the destroyer, <equo 
poede, enters our own door, in weeks of suspense, if 
not in the anguish of loss — needless loss — such as has 
been felt in 1,146 families of this city within five years- 
then only can be realized to the full the bitter penalties 
attached to the transgression of all well-known sanitary 
laws. 

"The direct money loss in the community from 
typhoid fever alone during the past five years may be 
readily estimated. The loss in wages, the expenditure 
on the attendance upon the sick, and the cost of the feed- 
ing may be placed at the very low average of $10 a 
week, which would make a total loss of $825,120 for the 
five years, above $165,000 a year, to say nothing of the 
yearly loss of 229 lives— lives too at the period oi 
est value to the State." 

Dr. Munro, medical officer of health for the county 
of Renfrew, England, gives an approximate cost of an 
epidemic, which occurred some years since in Mid-Ren 



276 PROPHYLAXIS. 

frewshire. " There were 859 cases, out of which seventy- 
four were fatal. The average cost of hospital treatment 
was about £8 15s., ($41.22) on which figure Dr. Munro 
puts the average cost of treatment all round at £^ 
($24. 20) per head, a figure which seems certainly well with- 
in the mark. From data to which he has had access, he 
puts the average wages lost to the patients at £3,291 
($15,928,44). The cost of funerals is taken at £5, ($.24.20) 
and the capital value of a human life at Farr's low figure of 
,£159, ($769.) The total pecuniary cost of the epidemic 
to the community of Mid-Renfrewshire was accordingly 
,£21,496, ($104,040.64), or just over £25, ($121.00) for 
each case. These figures are all calculated on the very low- 
est scale, and no doubt were in fact exceeded. If local 
authorities could realize such figures they would see that, 
quite apart from questions of sentiment or moral duty, 
no expenditure could yield a better interest on the in- 
vestment than that which is bestowed on the provision 
of pure water supplies and the establishment of isolation 
hospitals and adequate means of disinfection." 

During the last five years, 1889-94, there have oc- 
curred in Chicago from typhoid fever about 5,655 deaths, 
allowing ten cases of the disease for each death and ap- 
plying Osier's estimate of six weeks' illness, that city 
had 56,550 persons suffering an aggregate of 339,300 
weeks or 6,525 years of sickness ; if the loss in wages, 
the feeding, care and medical attendance of each one 
was worth ten dollars per week, there was expended on 
these items $3,393,000 ; if the funeral expenses of those 
who died averaged $25, and the life of each decedent 
from the disease — usually the young and vigorous — may 
be estimated at $1,000, it brings the cost of typhoid 
fever in this one city during the period mentioned to 



PROPHYLAXIS. 



•277 



the grand and enormous total of $9,189,375 and more 
than sixty-five centuries of " miserable " sickness. 

Mr. Sutherland has calculated that the loss to 
Great Britain by typhoid fever for the twenty years 
1861-1880 = ^23,300,000 ($112,772,000). " The deaths 
from typhoid fever in Scotland during the ten years 
1880-1889 show a gradual and tolerably regular diminu- 
tion from 1,335 deaths in the former year to 795 
deaths in the latter year ; but this is due to bettered 
sanitary conditions, and not to treatment. 

" Of 6,960 cases of typhoid fever in hospitals, 1,332, 
or 17.7 per cent, died." This is about the average 
death rate of Philadelphia at the present time. 

I quote the following statistics from Dr. J. YV. 
Moore's comprehensive work, "Eruptive and Continued 
Fevers" (1892). 



Year. 


No. of Cases of 
Typhoid Fever 
admitted to the 
Dublin Hospi- 
tals. 


No. of Deaths from 
Typhoid Fever in 
Hospitals. 


No. of Deaths from 
Typhoid Fever 
in Dublin Regis- 
tration District. 


1879 


367 
377 
169 
202 
182 
218 
265 
263 
276 
365 
783 
636 


36 
25 
22 
9 
18 
29 
22 
35 
28 
4 4 
79 
66 


205 


18S0 


188 


1881 


123 


1882. 


135 


1883 


132 


1884 


134 


1885 


144 


1886 


129 


1867 




1888 


168 


1889 




1890 


185 







The Cincinnati Lancet-Clinic on pa 
gives the following death rates for 1894 for the cities 



named : 



278 



PROPHYLAXIS. 



DEATHS FROM TYPHOID FEVER PER 100,000 OF POPULATION (1894). 



London 16 

Glasgow 20 

Rotterdam . . .- 5 
Stockholm ... 8 
Hamburg. ... 18 

Munich 15 

Buda-Pest ... 15 

Rome 34 

Dublin 87 | 

Prague 36 | 



Manchester 25 j Edinburgh. . . 14 



Paris 25 

The Hague 2 

Christiana. 6 i 

Dresden 4^ 

Trieste/ 17 

Brussels 27 

Turin 29 

St. Petersburg . . 51 

Milan 62 



Amsterdam. . 16 
Copenhagen . 9 

Berlin 9 

Breslau. . .... 10 

Vienna 7 

Venice 26 

Liverpool. . ..53 
Moscow 40 



There were returned to the State Board of Health 
for Michigan during the sixteen years 1867-1882, 7,957 
cases of typhoid fever, and 2,890 deaths from the dis- 
ease. In 1891 (the latest report at hand) there were 
returned 4,670 cases and 697 deaths. 

Dr. Guy McCandless, Registrar of Pittsburg, gives 
the number of typhoid fever cases reported in that city 
in July, August and September, 1894, at 407, and in the 
same months of 1895, at 526, an increase of 119. The 
number of deaths in 1894 was 46, and in 1895 was 49. 

Dr. McCandless says : " You will observe that 
there are more cases reported in 1895 than in 1894, with 
only three more deaths. I believe there are cases 
reported as typhoid fever in which the diagnosis was 
mistaken, for to my knowledge some of the cases re- 
ported were well and out in less than two weeks."* Dr. 
McCandless seems not to have known that some of the 
physicians of Pittsburg and Alleghany were during that 
period treating their cases of typhoid fever by the abor- 
tive method, several of them having written to me per- 
sonally for directions for the treatment. If all had used 



*Pittsburg Despatch of November 15, 1895. 



PROPHYLAXIS. 279 

this method scientifically instead of "some of the cases 
being well and out in two weeks," the average duration 
of illness of all cases would have been even shorter. 

There were reported in the District of Columbia in 
the decade ending June 30, 1894, 1,611 deaths from 
typhoid fever. In Cincinnati, from 1868 to 1894, there 
were 3,935 deaths, and in Boston from 1871 to 1894 — 
twenty-four years — there were 4,165 deaths from the 
disease. During the thirty-three years, 1862 to 1894, 
Philadelphia had 17,457 deaths from typhoid fever and 
applying the same low estimate already made for Chi- 
cago, it shows that from this one malady there was 
enough sickness in Philadelphia to cost that city $185,- 
480,625. There were 1,047,420 weeks, or 20,142 years 
of sickness, or enough to keep ten persons sick from 
the beginning of the Christian era to the present time, 
with more than twelve hundred years to spare. 

These statistics, incomplete as they are, are sufficient 
to give the reader some idea of the awful ravages oi 
typhoid fever in the near past, and I believe when the 
records of 1895 are compiled they will show the latter 
to have been the most fatal year in the history of this 
disease, the preventability of which calls for the institu- 
tion of some measures to arrest its devastating progress 
by providing for every member of the commonwealth 
unpolluted water to drink— but by whom ? 

That it is possible for the municipal authorities of the 
present day to do this is proven by the work ol the 
scientific engineers of long ago— and we surely have 
men of genius who can do all that they have den- 
successfully. The Greeks of Homer's time taught oi 
hygiene as well as of medicine. We read of Eupalinus, 
an engineer celebrated for the skill with which he con- 



280 PROPHYLAXIS. 

structed the works for the water supply of the city of 
Magara, during the reign of the tyrant Theagenes. 
(Circa 625 B. C.) One of the earliest forms of the 
aqueduct in which to convey pure water to the abodes 
of the people — that water which went so far toward 
making the Greeks the proverbially vigorous and 
athletic race they were — was the one on the Island of 
Cos, a part of which consisted of a bell-shaped chamber, 
built under ground in a hillside, in which to receive the 
water from a spring where it might be kept fresh by the 
air which was supplied through the airshaft. 

In Athens, 560 years before Christ, cold, pure and 
wholesome water was brought from the hills Hymet- 
tus, Pentelicus and Parnes — the ruins of which can still 
be traced in the village of Chalandri, by the airshafts 
which were from five to six feet in diameter. 

Tradition tells of the works of Empedocles, who 
brought water to the city of Selinus in Sicily, and there 
lived in Syracuse a man whose work was done for the 
ages — for his tunnels and pipes are still used for sup- 
plying the city with an abundance of drinking water. 

No obstacle seems to have been too great for the 
men of this ancient day to surmount, for they tell us of 
the tunnel for fresh water which passed under the sea 
to the Island of Ortygia — and all this was accomplished' 
successfully to conserve the health and comfort of the 
people. When one remembers the great achievements 
of the men of antiquity — looks upon the undertaking of 
Appius Claudius in constructing the Via Appia in the 
year of Rome 442, when the first attempt was made to 
supply from a distance the water to the City of the 
Seven Hills. When they .built the many series of 
arches and pillars in order to bridge the valleys and 



PYOPHYLAXIS. 281 

bring across the Campagna the water from the springs 
in the lofty Sabine Hills, making the aqueduct almost 
three hundred miles in length, erected the Porta 
Maggiore, through which the water was conducted in 
two separate channels, one above the other, and under 
which the traffic of the city might pass ; the remains of 
which make some of the most striking monuments of 
modern Rome. 

They were not niggards in those days, when the Cura- 
tores Aquarum had the oversight of the aqueducts and 
public waterways of the Republic or Empire, and their 
expenditures were most lavishly made but unfortunately 
their efforts did not seem to be appreciated, for during 
the middle ages these wonderful artificial provisions for 
the water supply were neglected to such an extent that 
many of the colossal creations — these triumphs in archi- 
tecture — are now in ruins. 

These aqueducts of solid masonry were a necessity 
to this people, for although they were not ignorant of 
the hydrostatic principle that water would rise to its 
own level they lacked the ability of making suitable 
pipes of the proper material to conduct these enormous 
quantities of water, for the use of cast iron was quite 
unknown. 

We do not labor under this difficulty for we have at 
our command the means of manufacturing so admirably 
this much needed article, and we are in general spared 
the vast expense of the stone aqueduct, and can bring 
our water from where we will at our pleasure But the 
rarity of these desirable conduits in modern time 
proportion to the number of cities which so greatly need 
them is marvelous. But neither are we niggards in this 
age of progress and prosperity. We hear of the great 



282 PROPHYLAXIS. 

system of waterworks which supplies Marseilles with the 
water of the Durance, by a canal sixty miles long, com- 
prised of many tunnels through mountains and aque- 
ducts across valleys, which is considered an extraor- 
dinary engineering feat of to-day. Most grand in design, 
solid in structure and of most extensive utility are the 
Ganges fresh water canal in Bengal, India ; the Croton 
aqueduct with its magnificent bridge across the Harlem 
River ; the famous and stupendous Manchester water- 
works system, with a conduit ninety-six miles long; the 
Loch Katrine aqueduct, which brings to Glasgow the 
pure and potable waters of this beautiful and noted lake; 
and the well-known conduit by which the waters of the 
Vyrnwy are conveyed to Liverpool. On the Continent, 
we find that the City of Vienna obtains her water from 
the Styrian Alps, a distance of almost sixty miles ; the 
water for Paris is brought about 110 miles to the 
reservoirs at Belleville when the waters of the Seine 
became too much polluted for domestic use. 

Thus in ancient and in modern times vast sums of 
money have been expended and herculean tasks under- 
taken to give pure and wholesome water for domestic 
use. In our day a few large cities have done much for 
the sake of sanitation, but the tendency in this age of 
the aggregation of large bodies of people in cities, and 
the short-sighted and selfish policy of each community 
to pour its sewage into the most convenient stream or 
lake, regardless of the injury it may do others if only it 
flows away from its own door, calls urgently for the 
inauguration of some means to prevent the wholesale 
pollution of fresh waters, whether of springs, rivulets, 
lakes or rivers. 

The authority of the City Health Board is practically 



PROPHYLAXIS, 288 

confined to the city's corporate limits ; that of the town- 
ship officers ends at the township line ; that of the 
county officials at the county line ; and the State Boards 
of Health can go no further than the State line ; while 
the causes which produce the disease may come from 
without their jurisdiction. But the authority of a Secre- 
tary of Public Health of the United States would not 
only be coextensive with its boundaries, but wherever 
the American flag waves he could make his influence 
felt for the good of mankind. Therefore I repeat that 
a Department of Public Health is a public necessity, 
and the appointment of a Secretary of Public Health is 
demanded alike by the highest and by sordid motives. 

That this official, if competent and clothed with 
adequate power, could save the country many millions 
of dollars annually is easily demonstrable. That he 
could prevent a vast amount of sickness and suffering 
and the unnecessary sacrifice of many thousands of 
lives during the first year — and in an increasing ratio 
during each succeeding year — of his incumbency is 
equally certain; and the government of the United 
States will not have attained its full stature— the cul 
minating point of its influence for the highest benefit of 
all of its citizens, the zenith of its greatness until a 
Bureau of Public Health is one of its integral and co- 
equal departments. 

Sanitary science should find a place in the man- 
agement of every individual case of contagious or 
infectious diseases; therefore, the duty of a medical 
attendant on cases of typhoid U:\<-v is to see thai 
all of the evacuations of every emunctory of the 
patient— the sputa, the urine, the vomit, as well 
all the alvine dejections are disinfected as soon as 



284 PROPHYLAXIS. 

voided, nor should he await the development of pa- 
thognomonic symptoms of typhoid fever before attend- 
ing to this important matter any more than before 
commencing the abortive treatment. The body and bed 
linen, especially if soiled by excrement, should receive 
scrupulous attention and should be put into some disin- 
fecting solution,* or better in boiling water. These 
precautions are especially important in the country 
where there is the greatest danger of contaminating the 
water supply. Every practitioner, however, who does 
private practice will realize how easy it is to have 
these directions followed for two or three days, while 
the patient is not very ill, but how difficult — how impos- 
sible it is to have these sanitary precautions attended to 
for weeks, when those whose duty it is to care for the 
sick, as well as guard the health of the uninfected, are 
(as is too often the case) the immediate relations of the 
patient, who is perhaps passing dangerously near the 
brink of the grave, and all around are overwhelmed with 
anxiety ; or perhaps one or two members of the family 
have passed to the great beyond, and in addition to the 
anxiety for the living is added grief for the dead. How 
much this labor of disinfection will be lightened, and 
rendered more efficient by the abortive treatment, only 
he who has passed through both experiences can tell. 
Antiseptic treatment in typhoid fever will prove to be of 
greater value to humanity, if possible, as a prophylactic 
than as a curative measure. It is much more than four 



*There are on the market many manufactured or proprietory disinfect- 
ants, but there is nothing better than a simple solution of hydrargyrum chloridum 
corrosivum or ferrum sulphatum (corrisive sublimate or copperas), and these 
possess the advantages of being both convenient and inexpensive. Other good 
and efficacious disinfectants are zincum chloridum, acidum sulphurosum, and 
chlorinum. 



PROPHYLAXIS. 



285 



times as difficult to have thorough sanitation for four 
weeks, than for one week. It is very much more difficult 
to have sanitary matters attended to when the patient is 
very sick, and every one anxious and perhaps over- 
worked, than when the patient is but mildly ill, requiring 
no special care and causing no anxiety. No language 
can picture the difference between the results of the 
antiseptic and the " expectant method " of treating 
typhoid fever as shown in the condition of the patients. 
Still less can any pen indicate the advantage to human- 
ity of the abortive treatment of the disease, arising from 
the shortened period of time during which the patient is 
a menace to the community, even though the hope should 
prove to be groundless, that by asepticizing the ali- 
mentary canal the alvine dejections are rendered innoc- 
uous. This point assumes higher importance from the 
conclusion of the Clinical Society of Great Britain, 
that "a person suffering from enteric fever is capable of 
conveying the infection to others throughout the whole 
course of the disease, from the date of the earliest symp- 
toms of illness until convalescence has been established 
for at least a fortnight." 

As typhoid fever is essentially a water borne disease 
it seems to follow that it is almost as frequently dissemi- 
nated by the use of contaminated milk. Mr. I [art, writing 
in 1881, said : " The influence of milk in spreading 
motic diseases was then almost a new danger revealed by 
hygienic science. Ordinary measures oi sanitary (don 
tic) precaution do not seem to avail to secure immunity 
against the incidence of dis< i spread, although the 

boiling of milk was seen to be a method of rendering 
that article innocuous." 

The well-known property of milk of absorbing odors — 



286 PROPHYLAXIS. 

the fact that it is an excellent culture medium for disease 
germs, and that it has been known to be the prime factor in 
the spread of many epidemics of disease should, without 
farther teaching lead to its universal sterilization by heat. 
Milk has been responsible for so many outbreaks of 
typhoid fever in this country, that we instinctively in- 
quire about the source from which the supply of that 
fluid is obtained as soon as we see a case of the disease. 
These outbreaks have all resulted from using polluted 
water with which to rinse the milk cans or adulterate the 
milk, with few exceptions — one heretofore mentioned 
as having occurred in a village near Leeds, England, 
during the summer of 1876 and reported by Dr. R. P. 
Oglesby ; and another occurring in Bayhead, New Jer- 
sey, during July 1894, reported by Dr. W. H. Katzen- 
bach to the New York Clinical Society, October 1894, 
which included fifteen cases of the disease. 

In this instance the first patient came from Whites- 
ville, fifteen miles distant, to take charge of a herd of eight 
or ten cows, " which he stalled and pastured on a small 
farm, . . . and milked daily until July 11th, when, un- 
able to be about any longer, he took to bed." From the 
facts offered it is fairly conclusive that the milk was not 
contaminated by the " water used in the cans for cleans- 
ing or dilution. The only way, consequently, in which 

the milk could have been infected was by Fred J 's 

hands. How this could occur can be left to the imagina- 
tion of those who are familiar with the personal habits of 
some who work on dairy farms." 

Dr. Welphy, of Belfast, Ireland, has noted in his 
article, " Creameries and Infectious Diseases," an in- 
fected dairy was the cause of the certain outbreak of 
typhoid fever, and shows how minute a quantity ofmor- 



PROPHYLAXIS. 



287 



bific matter is capable of "well nigh indefinite multipli- 
cation in such an ideal culture medium as milk." He 
found in his examination that the cows in this dairy 
were milked by a person whose hands had been soiled 
by typhoid dejecta, and that some of the dairy maids 
acted also as nurses to the sick." 

The bright, spicy and independent Sanitary Era, 
June, 1895, gives the following: 

" In Stamford, Conn., the local health officer reports 
337 cases (in a population of 16,000), of which 307 have 
been traced positively to the milk supplied by one dairy- 
man, and thence to shallow wells near his barns, which 
furnished the water in which he rinsed his milk cans, 
and which water was foully contaminated from a little 
settlement of Italians close by. . . . The typhoid 
bacilli were found abundant both in the water and the 
milk of this dairy. 

"In New Milford, Conn., twenty-three cases of 
typhoid fever have been traced to the milk from a herd 
of cows that were milked by a laborer suffering from the 
disease. 

"The above epidemics are a continuation of the reg- 
ular line, running back through those of Montclair, New- 
Jersey, Springfield and Somerville, Mass., Waterbury, 
Conn., etc." 

The -knowledge that could be gained from an inti- 
mate association with some of those who milk and care 
for cows, might have a salutary effect upon some munic- 
ipal lawgivers, though it might also destroy their ap- 
petite for this almost universal article of diet 

I fancy some members of the Roman syndic have 
visited some of Rome's out lying modern dairies, since- 

" For some time past excellent regulations have I 



288 PROPHYLAXIS. 

in force in Rome proper, in relation to the health of 
milch cows and other animals which supply milk to the 
residents. By order of the syndic just issued similar reg- 
ulations are put in force for the whole of the commune, 
which includes a considerable extent of the surrounding 
Campagna. They are to the following effect : All milch 
cows and other animals which supply milk in the sub- 
urbs and Agro Romano will be subject to a rigorous ex- 
amination by the municipal veterinary surgeons. To 
this purpose, notice of every animal introduced into the 
commune must be given to the health authorities before 
the milk can be sold, and it is then placed under the in- 
spection of the veterinary surgeon. When the animal 
is healthy and capable of furnishing good milk it will be 
marked in the horn, and a special license will be given 
to the owner." 

Until some laws similar to the above are made and 
enforced in this country, and until we know who does 
the milking, it would be the part of wisdom to sterilize 
all milk used for domestic purposes, and especially for 
the sick room, and while treating typhoid fever it 
should not be used until perfectly sterilized by heat 
The unpleasant flavor of boiled milk can be avoided if it 
is prepared in a closed vessel and immediately put into 
the refrigerator to be cooled. The addition of benzoic 
acid to milk cannot be too strongly condemned. It is 
fortunate for man that the earliest fermentative changes 
render milk acid before becoming putrescent, but the 
most of the chemical preservatives retard the acid fer- 
mentation without arresting putrefactive changes. 

Every outbreak of typhoid fever which cannot 
be traced to the use of infected milk, may be assumed 
to depend upon water pollution — notwithstanding the 



PROPHYLAXIS. 

very able arguments of Dr. Priestly at the last meet- 
ing of the British Medical Association. Long before 
the true pathogeny of typhoid fever was even sus- 
pected careful observers had connected outbreaks of 
the disease with the water supply, and even as late as 
1854, that great scientist, Pettenkofer, regarded the 
oscillations of the water in wells as in some mysterious 
way giving origin to the disease without realizing that 
its pathogenic influence is due to the pollution of the 
water with human excrement, and that variations in the 
level of the ground water merely gives opportunity for 
its contamination, which sometimes produces effects 
apparently out of all proportion to the cause ; as at 
Winnefrede, West Virginia, where a single case of ty- 
phoid fever caused an outbreak of 154 cases in a com- 
munity of 1,600 souls, by the pollution of a single spring 
and the stream flowing from it ; or at Plymouth, Penn., 
where 1,200 cases were the result of the contamination 
of the water by the excrement of a single patient. 

The drainage from cemeteries where victims of ty- 
phoid fever have been buried, have also been the proba- 
ble cause of many outbreaks of the disease, as at 
Watertown, New York, where a large number of < 
occurred during the summer of L895. Professor Prest- 
wick has pointed out that the growth of London 
restricted till the establishment of a system supplying 
the inhabitants with an abundance of other than the 
sparkling water of old shallow wells which had 1 
contaminated by infiltration of water from graveyards 
and elsewhere. 

In my own practice, some of the most seven 
have ever treated seemed to be the direct result of the 
pollution of well water by drainage from cm A 



290 PROPHYLAXIS. 

powerful argument in favor of cremation of bodies dead 
from contagious diseases, as well of sewage ; therefore, 
no water from any suspected source should be admitted 
into the sick room to be used as drink until it has been 
sterilized. 

These simple precautions are all that are necessary 
to protect the community, the family and the nurses 
from the infection of typhoid fever, as well as to guard 
the patient from the danger of reinfection. There is no 
real danger of communication of typhoid fever from the 
patient directly to the nurse or to any one else. 

The science of bacteriology has refuted the con- 
tagion theory of Bretonneau, Leuret, Gendron, and the 
host of observers who believed that the disease could 
be transmitted through the air and has confirmed the 
teachings of Budd that every case of typhoid fever is 
the child of some previous case — that the pathogenic 
principle is voided with the excrement of the patient, 
and that it is capable of such wide diffusion that all of 
the inhabitants of a populous city might be infected by 
the discharges from a single case of typhoid fever. 

Murchison, in summing up the evidence of the conta- 
giousness or noncontagiousness of typhoid fever, says : 
" But the most remarkable fact is what follows. Since 
1861 it has been the practice to classify the patients in 
the fever hospital in this way. The typhus, relapsing, 
and scarlatina patients have been kept in distinct wards, 
whereas the patients suffering from enteric fever have 
been treated in the same wards with the many patients 
sent to the hospital, who have not been the subjects of 
any form of contagious fever. The two classes of pa- 
tients have remained together, both during the acute 
stage of their maladies and in convalescence, in most in- 
stances for several weeks. 



PROPHYLAXIS. oi)] 

"The same night chairs have been used by both 
classes, and the employment of disinfectants has been 
exceptional. The result has been this : During the 
nine years 3,555 cases of enteric fever have been treated 
along with 5,144 patients not suffering from any spe- 
cific fever ; not one of the latter has contracted enteric 
fever. My experience, in fact, has led me to the con- 
clusion that when enteric fever originates in the hospital 
as a rule there is something radically defective in the 
sanitary arrangements, and that either the air or drink- 
ing water is polluted with decomposing excrement." 



TREATMENT. 

The abortive treatment of typhoid fever is hedged 
around with many barriers and obstacles, which are 
all the more difficult to surmount because of the existing 
uncertainty as to its true pathogeny, but whether we as- 
sume that it is due to the presence in the system of the 
Eberth bacillus and its toxins, to a virulized bacillus 
coli cummunis or to some other noxious influence, 
the indications for treatment, though numerous, and in 
some respects obscure, are in others clear and well de- 
fined. To reinforce the natural power of the body to re- 
sist the encroachment of disease, to destroy and neutral- 
ize and eliminate as much as possible of the poison before 
it or its toxins have passed beyond their earliest usual 
habitat in man — the alimentary canal — and to reach into 
the general circulation and render innocuous the 
ptomaines, toxins, typho-toxin, tox-albumens or what- 
ever interferes with the patient's health or comfort. 

In early stages of uncomplicated typhoid fever in the 
adult, the patient should be regarded and treated simply 
as the container of the poisons, and when they are de- 
stroyed or neutralized and the container cleansed, nature 
will restore to each organ its normal function and all 
symptoms of the disease will disappear. 

The treatment, to meet all of the indications, must be 
antiseptic, laxative, diuretic, and diaphoretic ; it must be 
more even than all this — it must have power to devitalize 
or render nontoxic all of the lethal or deleterious ele- 
ments that have entered the system, whether circulating 

292 



TEE A TMENT. 093 

in the blood or migrating through the various tissues 
and organs of the body. It must also be harmless to 
the healthy organism, and since a positive diagnosis of 
typhoid fever at a sufficiently early stage to abort the 
disease is sometimes impossible, it should be incapable 
of injuring the patient in any pathological condition that 
could be mistaken for that disease. 

From the little we now know — and the much we imagine 
— of the cause and origin of typhoid fever, we may sur- 
mise that upon the invasion of the human system by the 
materies morbi of the disease, war is immediately in- 
augurated by the protective alexins, which is sometimes, 
no doubt, waged for days or even weeks with uncertain 
results, ending frequently in all probability in such easy 
and complete victory for the alexifers, that the patient in 
whom this internecine battle is fought is and remains 
totally oblivious of the great problems which are being 
solved within him — ending sometimes in a closer contest, 
but in ultimate victory — in this we recognize the " abort- 
ive attack, " — and again in a rout for the health restoring 
friend of man — this is the prolonged and often life destroy- 
ing attack — and now while this conflict with one specific 
poison is in progress, the enemy may be reinforced by- 
other kindred noxas or morbific influences from without, 
or even developed within the organism, for we have to do 
with a pathological as well as with a physiological 
and chemical laboratory— with a creator as well as a 
receiver of poisons — and here we have those dangerous 
complications and sequela? so common in typhoid fever. 
To guard the patient against the dangers of these most 
frequent causes of a fatal termination of typhoid fever, 
constitute one of the most imperious demands for the 
early abortion of the disease. 



094 TREATMENT. 

It not infrequently occurs that an attack of typhoid 
fever which has run a mild course, suddenly assumes 
a malignant type, and may we not see here the defeat of 
the friendly alexins, the abuse of the victory of the 
pathogenic influences and an imperious call for the ad- 
ministration of alexipharmacons. 

Since the principles that govern the abortive treatment 
of typhoid fever govern also the treatment of a large num- 
ber of other microbic diseases, and if the exact formulas 
which have thus far proven most puissant for this purpose will 
not also cure all of the diseases that could be mistaken for it, 
they will at least put the patient in the best possible condi- 
tion to recover from any pathological state at all resembling 
this disease. Hence it is not necessary to await in worse 
than idleness the development of such symptoms as would 
make an exact diagnosis possible. 

As the so-called pathognomonic symptoms of this dis- 
ease, with one doubtful exception, are evidence of already 
existent anatomical lesions, it becomes apparent that to 
await their supervention would be unwise. Thus the 
earlier the alexipharmics are exhibited the easier it will be 
to abort the disease, and the less will be the danger of 
relapses or grave complications. 

This treatment to be invariably successful must be com- 
menced in time to admit of resolution before necrosis of 
Peyer's glands takes place ; therefore the first time a 
patient who is or who could become a victim of typhoid 
fever is seen, the antiseptic treatment should be instituted — 
the indisposition may be ever so insignificant, the symptoms 
far from characteristic — there may be but a trifling head- 
ache, a slight acceleration of the pulse and a scarcely per- 
ceptible elevation of the temperature. Upon such data one 
could not base a diagnosis of typhoid fever, but it would be 



TREATMENT. 095 

equally impossible to exclude it from the list of the maladies 
from which the patient may be suffering. Consequently, it 
is the physician's plain and imperative duty to give the 
patient the benefit of every doubt in a question of such 
vital importance to him ; the more so because this antiseptic 
treatment is innocuous and uninjurious, and the patient need 
be put to no inconvenience or discommoded in any way — 
may in fact be allowed every liberty and latitude to the 
extent of following any ordinary avocation. 

If convalescence follows the exhibition of a few doses of 
medicine no harm has been done, and the patient will be 
the better for having taken the antiseptic — but if charac- 
teristic symptoms of typhoid fever declare themselves, the 
physician will have conferred an inestimable blessing upon 
the patient by having begun the treatment early, and thus 
warded off all the danger of death and delivered him from 
the hazardous and disastrous ravages of the malady and the 
perils of its many complications and sequelae. 

But as it is not always possible to know just how severe 
the intestinal lesions may have become, every possible pre- 
caution and forethought must now be taken to guard 
against accident or injury to the inflamed abdominal visa ra. 

The nurse must be directed to exercise all devotion to 
her patient, and be vigilant and prudent and alert in the 
performance of every duty, and exact and attentive in the 
management of every detail, and withal cheerful and agree- 
able. 

The sick room should be sunny and bright, well ven- 
tilated, clean in every sense of the word, and as free from 
draperies and superfluous furniture as possible. No rem- 
nants of food or drink or the dishes upon which cither has 
been served should be left within it, and all soiled garments 
transferred to be disinfected and all excrementitious mai 



296 ' TREATMENT. 

removed as soon as voided, and subjected to the action of 
proper disinfectants. 

The bed and bed linen should be perfectly clean and 
spotless, and changed as frequently as is consistent with the 
patient's rest and comfort. Care should be taken to replace 
immediately all articles that may become stained with ex- 
crementitious matters. The covering- of the bed should be 
light, but (especially in late stages of the disease) suffi- 
ciently warm to meet every demand of comfort and protec- 
tion to the invalid. 

When put to bed the patient should be sponged and 
well rubbed with a course towel, and this should be re- 
peated as often as necessary to keep the skin active and 
free from morbific materials. The body linen should be 
clean and stainless, and should be changed frequently. 
The nurse should endeavor to beguile away the time and 
soothe and reconcile her charge to his invalidism, humoring 
his fads and fancies when they do not interfere with his 
welfare, that his peace of mind and his serenity may aid in 
his rapid recovery, for by repining and bewailing, his ner- 
vous symptoms are aggravated and their alleviation delayed. 
She should guard the sick man from all unnecessary dis- 
turbances, the turmoil and agitation of the world should be 
kept from his ears, especially if nervous symptoms pre- 
dominate, and except in case of emergency no other person 
should be allowed to remain for any length of time in the 
sick room, and low talking and whispering in his presence 
should be absolutely forbidden. It should be her duty to 
administer every portion of medicine, every particle of food 
and even every drop of water, only as and exactly as pre- 
scribed by the medical attendant. All medication and all 
nutriment should be given promptly and at proper intervals. 
No routinism should be permitted in regard to the bath. If 



TREATMENT. 297 

the patient is bathed at all it should be done in accordance 
with and at the time specified in the orders of physician. 

A clinical record should be kept at the bedside of each 
patient which should show at a glance the following data : 
The name, age, sex and occupation of the patient, the day 
of the disease when first seen by the physician, the morning 
and evening temperature, the frequency and character of 
the pulse beats, the number and character of respirations 
per minute, the date of the institution of the treatment, the 
number and exact character of stools, the quantity and 
quality of urine voided, condition of the tongue, and any 
other important clinical features under the head of " re- 
marks." The record should also show the kind, size and 
number of doses of medicine taken and the time at which 
they were administered, the quantity and sort of food and 
the intervals at which it was given, and even the quantity 
of water drank. For thus only can the physician see that 
all of his orders have been obeyed in the most minute 
detail. For the collection of scientific data the record- 
should be more complete ; z. e. y the date of the appearance 
and the character of all symptoms, as well as the date of 
their partial and total disappearance. 

Unless the physician is ably and efficiently seconded by 
a thoroughly competent, thoroughly careful and intelligent 
nurse, his talents will be of minor importance, his efforts 
hampered and his success in aborting this hitherto refi 
tory disease seriously imperiled. His records, too, (upon 
which the final adjudication of the question as to the power 
of antiseptic medicine over microbic di must r 

will be valueless for all scientific purpose 

As the curative treatment of typhoid fever depends 
quite as much upon the withholding of dangerous i 
terious medicines or such as interfere with either the admin- 



298 TREATMENT. 

istration or effect of the antiseptics or on the proper admin- 
istration of the latter, it is fully as important a matter to 
point out and correct the errors of the "old method" of 
treatment as to promulgate the intrinsic merits of the new. 
Much has been said and written by earlier authors 
about "treating dangerous symptoms " and especially about 
keeping the temperature down within " safe limits.' ' Phy- 
sicians of the present day are so prone to follow this unwise 
and irrational advice — a most reprehensible practice, at least 
in the first week or so of the disease in the adult — and the 
opinion that a high temperature is the chief source of peril 
is so general in the medical profession that it is necessary 
to warn its members against medicinal antipyretics. No 
doubt some of the advocates of the Brandt method of treat- 
ing typhoid fever are responsible for this erroneous idea, 
since they, in accrediting the benefits resulting or supposed 
to result from the cold bath, place a reduction of the tem- 
perature first in importance, and make this symptom the 
indication for its repeated use. 

The greatest therapeutic advantage to be derived from 
the bath is due to the increased elimination of the toxins 
and perhaps in a lesser degree to its stimulating effect and 
not to a lowering of the temperature — which may not be an 
unmixed blessing. A temperature of 105° or 106° F. prior 
to the softening or sloughing of any of the intestinal glands, 
in the adult, is not of itself fraught with extreme danger and 
is a danger signal only so far as it is indicative of the pres- 
ence in the system of a conquering pathogenic influence. 
The truth of this proposition would seem to be established 
by the fact that a much higher temperature than is usually 
seen even in fatal cases of typhoid fever is not very uncom- 
mon in other ailments from which the patients recover with 
little exhaustion of the vital forces. 



TREA TMENT. 099 

But three cases of typhoid fever with a temperature of 
107° F. have ever come under my observation, while I have 
seen a patient recover from rheumatism without material 
loss of flesh or strength, whose temperature taken in the 
axilla registered 110° F. 

Hence whatever we may think of the cooling effect of 
water — applied externally — there can be no question but 
the use of the cold bath and its apparently beneficial 
effects has (by inducing physicians to resort to ail sorts of 
medicinal antipyretics) been the cause of much pernicious 
practice, through which many valuable lives have been 
sacrificed. Their use is not more defensible than is that of 
the corrosive poisons as microbecides and the physicians 
who will employ energetically the coal tar derivatives as 
antipyretics and corrosive sublimate as a germicide may kill 
more patients than could the most malignant epidemic of 
typhoid fever. Therefore give no corrosive or irritant poi- 
sons as a means of destroying the germ, and none of the 
coal tar products as antipyretics — they are never beneficial 
— they are always harmful — they are often perilous and 
sometimes will cause a fatal termination; when nature, un- 
aided, might have exterminated the disease and not killed 
the patient. 

Quinine should be administered in the treatment of 
typhoid fever only as a tonic and in very small doses late in 
the disease. The large doses sometimes administered to 
control the temperature are valueless for the purpose for 
which they are prescribed and are decidedly detrimental to 

the patient. 

Alcohol, so largely used by many practitioners should 
have no place amongst the therapeutic agents applied to 
the curative treatment of this disease. Its use. il usi d at 
all, should be limited to such cases as have pa ond 



300 TREATMENT. 

the power of abortive treatment, when toxaemia threatens 
the life of the patient — when the nervous symptoms become 
alarming or exhaustion is extreme, then it may possibly 
prove to be beneficial and should be poured with a lavish 
hand at least when used as a nervous sedative. 

Diarrhcea. — -This is another "symptom" which those 
who treat typhoid fever " symptomatically " usually make 
most heroic and unwise efforts to arrest. This is wrong — 
the diarrhcea is an expression of nature's objection to the 
presence in the system of obnoxious matter, and it is her 
method of getting rid of it; and to check it, would be to 
defeat one of her most laudable efforts. It would be wiser 
to encourage her by giving a simple laxative or cathartic — 
at least, give no opium or astringents. When the alimen- 
tary canal has been thoroughly asepticized the diarrhcea will 
cease. 

Dr. Woodbridge, of Williams College, Massachusetts, 
a fi rm believer in the possibility of aborting typhoid 
fever, and an early advocate of the antiseptic treatment of 
the disease, says: "The advantage of an active laxative in 
the initial stage of the disease is too generally conceded to 
admit of doubt — an advantage shown on reduction of the 
number of the micro-organisms and in the reduction of tem- 
perature/' 

In every pathological condition from which diphtheria, 
pneumonia, meningitis, cholera-infantum, scarlatina, rubeola 
and typhoid fever cannot.be excluded, antiseptics should be 
exhibited. 

Every hour from the moment in which the poison is in- 
gested until the patient is under the mystic spell of anti- 
septics is precious, therefore, every resource at the physi- 
cian's command should be utilized for the purpose of asepti- 
cizing not only the alimentary canal, but also the whole 



TREATMENT. ;> )01 

organism as thoroughly and as rapidly as possible, and as 
soon as the presence of the virus has become manifest. 
The graver the symptoms, the more heroic should be the 
treatment. 

Assuming that an adult, not suffering from any concur- 
rent affection is found on the ninth to the eleventh day of an 
attack of typhoid fever in the following condition : Tem- 
perature 105° F.; pulse 120; headache severe, insom- 
nious ; profuse bronchial catarrh ; palpation reveals tender- 
ness and gurgling in the right iliac fossa or possibly in the 
left, or even generally over the abdomen some tympanitic 
distention; no enlargement of the spleen; margins of the 
tongue red; the center coated, brown and dry; the mind 
wanders in delirium but the patient can be aroused ; the 
characteristic rose spots are present ; there is a history of 
epistaxis, as well as of chills or chilly sensations earlier in 
the disease. The bowels may be constipated or the patient 
may have an alarming diarrhoea, but there has as yet been no 
intestinal haemorrhage. This patient is rapidly passing, if 
he has not already passed, beyond the reach of abortive 
treatment. Therefore let no time be lost. Be sun.' that 
every dose of medieine exhibited is properly prepared of 
pure and active drugs, properly administered at the proper 
time, and that every day of treatment has accomplished its 
just proportion of the cure. This patient should h;i\ e I 
for some days confined to bed; he should be required to 
maintain at all times a recumbent position, and on no ac 
count allowed to rise even to evacuate the bladder, or to 
assist in raising his hips to permit the placingofthe bedpan 
or draw-sheet He should be sponged etc., and the instruc- 
tions given to the nurse on a previous page should be 
rigidly enforced. The diet should consist exclusivel] 
liquids of the most assimilable sort and such as l< 



302 TREATMENT. 

the least detritus, of which milk, peptonized, or not, should 
have the first place. Should tough curds be formed, it 
should be peptonized or mixed with a modicum of lime- 
water. If necessary the milk may be replaced in whole or 
in part by Fairchild Brothers & Fosters Panopeptin. 
Meat juices or broths, or egg albumen may be allowed. 
These foods should be continued to the exclusion of all solid 
or less digestible liquid articles of diet for at least ten days 
after the rectal or sublingual evening temperature has been 
normal, or in very severe cases for five or six days longer. 
Food should be given at regular intervals of not less than 
three hours, with a longer interval in the night, and as lib- 
erally as is consistent with complete digestion and assimila- 
tion. 

Treatment. — Begin the medicinal treatment of this pa- 
tient with formula No. 1. 

#. No. 1. Podophyllin resin -§\§ gr. 

Mercuous chloride, mild ... j\ gr. 

Guaiacol carbonate „ T ^ gr. 

Menthol , . , , T V gr. 

Eucalyptol q. s. 

Make one tablet. 

Give one of these tablets every fifteen minutes during 
all of the wakeful portion of the first forty-eight hours. 
There will usually be little inclination to sleep during the 
first and second nights of treatment, so that from 80 to 100 
or more tablets may be given. As it is essential to the 
success of the treatment that the medicine be distributed in 
minute portions over a considerable period of time, with no 
long breaks, the patient should be aroused if necessary 
often enough to take the required number of doses. Equal- 
ly 'important is it that each and every dose of medicine ad- 
ministered should be washed down with large quantities 



TEE A TMENT. 

of distilled, sterilized, or if not contraindicated, some eood 
laxative or diuretic mineral water. 

The most useful potation for general purposes, be- 
cause it is the most highly solvent, is distilled water, 
lightly charged with carbonic acid gas, preserved in 
tightly stoppered bottles. As it is slightly sparkling, if 
kept moderately cool, it proves to be a most agreeable 
beverage. 

If vomiting be troublesome, a little menthol may 
be exhibited, or a sinapism may be placed over the epi- 
gastrium, but the tablets should be continued uninter- 
ruptedly, and will themselves usually arrest the emesis, 
and relieve the nausea. 

At the end of twenty-four hours begin with formula 
No. 2, each tablet of which contains : 

#. No. 2. Podophyllum resin ^-J T gr. 

Mercurous chloride, mild. x \ gr. 

Guaiacol carbonate } gr. 

Menthol ,V & r - 

Thymol V 6 gr. 

Eucalyptol q. s. 

It will be noted that formulas Nos. 1 and 2 differ only 
in the addition of guaiacol carbonate 3-16 gr. and thy- 
mol 1-16 gr. to each tablet. So slight adifference might 
seem unnecessary, but experience has shown that some 
patients require so many tablets to produce the desired 
effect, that by taking £. No. 2 from the beginning of 
the treatment an unnecessary quantity of guaiacol I 
bonate and too much thymol would be administered, 
thus impairing the normal function of the Stomach and 
possibly the integrity of the kidneys. 

Give one tablet of this formula every fifteen mini 
together with the one or more tablets of formula No. I, 



304 TREATMENT. 

until five or six free evacuations of the bowels have been 
procured during- this and the following- day. It some- 
times happens that the tablets of formula No. 1 produce 
sufficient relaxation of the bowels during the first twenty- 
four hours, in which case they should be promptly dis- 
continued and No. 2 administered with just the requisite 
frequency to secure the desired effect. Those who have 
had no experience with this treatment are shocked when 
advised to give medicine every fifteen minutes, both 
night and day, and seem to think it would be a fearful 
hardship to the patient to take it in this manner. The 
fact is, the patient with typhoid fever rarely sleeps dur- 
ing the first two nights of treatment, and if they do, they 
can easily be sufficiently aroused to swallow the tablet 
and a draught of water, without being fully awakened 
and will drop off to sleep again immediately. It is sel- 
dom that this frequent administration of medicine has to 
be continued longer than the second night. 

If diarrhoea be a prominent symptom when the treat- 
ment is begun, and if it be not arrested by the antisep- 
tic action of the tablets, the stools should be carefully 
watched for this effect, which will be manifested by the 
change in character and loss of offensive odor. Some- 
times the cathartic effect of the medicine follows so closely 
upon its antiseptic action, that the diarrhoea of the disease 
runs imperceptibly into the purgative effect of the medicine, 
in which case the tablets must be continued but at longer 
intervals. 

Not less than six free evacuations of the bowels hav- 
ing been secured during each of two successive periods 
of twenty-four hours, the dosage of formula No. 2 may 
be lightened, by giving the medicine less and less frequently 
each day, and thus allowing the alvine dejections to grad- 



TREATMENT. 3Q5 

uaiiy diminish to two or three evacuations at the end of 
the first week. 

About the third or fourth day, or as soon as the medi- 
cine has produced sufficient elimination and all danger of 
emesis interfering with the treatment has passed, formula 
No. 3 should be administered, each capsule of which con- 
tains : 

#. No. 3. Thymol 1 gr . 

Guaiacol carbonate 3 grs. 

Menthol y 2 gr. 

Eucalyptol 5 m. 

Give one of these capsules every three hours until the 
temperature has been normal at least three days. 

About the fourth or fifth day, or as soon as the evac- 
uations of the bowels have become sufficiently active and 
before any ill effects of the mercurial manifest themselves, 
discontinue the tablets and give of a saturated solution of 
chlorate of potash one teaspoonful every two or three 
hours until diminished activity of the bowels indicates the 
necessity of returning to the tablets No. 2, or if the stomach 
is irritable to No. 1. 

The administration of formula No. 3 should not be 
allowed to interfere with the exhibition of formula No. 
2, but if the bowels become too active the tablets should 
be discontinued for a day or two at a time, and No. 
3 exhibited, returning to them as soon as possible. Ii, h(W 
ever, in cases of extreme costiveness, a very large quan- 
tity of the medicine has been necessary to secure the de- 
sired laxative condition, vigilance should be maintained for 
the slightest symptoms of ptyalism, and should they 
supervene, formula No. 3 and teaspoonful d of a 

saturated solution of chlorate of potash should be given 
at three hours intervals, for two or three days if n< 



306 TREATMENT. 

It is sometimes advisable too to replace formula No. 
2 with some mild saline cathartic, and in very consti- 
pated cases to substitute for the distilled water some 
gentle laxative mineral water. 

The tendency to grave renal complications in typhoid 
fever is an attestation of the importance of using every 
possible precaution to protect the kidneys from all morbi- 
genous influences, a purpose best conserved by diluting 
the urine and removing its irritating qualities. This is gen- 
erally satisfactorily accomplished by the medicines already 
advised, but a mildly diuretic mineral water, in a certain 
class of cases, may be highly advantageous. 

If the excretion of these organs is of very high specific 
gravity, a diuretic mixture such as the following should 
be given for a day or two, but it should be discontinued 
as soon as the urine is clear and bland. 

R. Potass acet ounces 2. 

Spir. nitri. dale ounces }£. 

Aquae dest q. s. ad. ounces 6. 

S. Dose, ateaspoonful in a large draught of distilled water 
pro re nata. 

After such management chemical analysis or the micro- 
scope, will rarely show albumen, or casts, or other evi- 
dences of any pathological condition of the kidneys. 

The severity of the symptoms given in the hypothet- 
ical case of typhoid fever, emphasize the importance of 
guarding against these ordinary complications, indicate 
that the mesenteric glands were tumefied, that the spleen 
and liver were involved, and that necrosis and ulceration 
of Peyer's glands was imminent, if indeed, these conditions 
were not already present, and notwithstanding the rapid 
amelioration of all the symptoms, we have no means of 
knowing the exact state of the intestinal glands. Some of 



TREATMENT. 307 

these may be deeply ulcerated, and although we at once 
put them in the most perfect consonescent condition, we 
have yet to avoid the danger of intestinal haemorrhage 
and perforation. The patient must therefore be confined 
to a state of complete rest and a liquid food, until all 
danger of these accidents — his only peril — has passed. 

During this, the second week of the treatment, the tem- 
perature should be carefully watched and on the slightest 
elevation tablets of #. No. 2 should be administered as fre- 
quently and as boldly as at the beginning of the treatment, 
and under all circumstances the bowels should be kept free 
and active, moving once or twice each and every day, and 
the capsules should be continued until the patient is re- 
stored to perfect health. 

This type of the disease was purposely chosen as it was 
on the very border line dividing the curable from the in- 
curable stage of typhoid fever. It would be by far the 
most difficult variety to abort, and would be liable to all of 
the complications so general in this disease under sympto- 
matic treatment. But for these reasons much of the cau- 
tion as to diet and rest, and much of the advice as to the 
administration of medicine would be entirely superfluous. 
Had the same patient been put under efficacious treatment 
a few days or it may be a few hours earlier, there would 
have been no chance for any of the peculiar and annoying 
complications of this dire disease. 

Complications involving the lungs are various in kind 
and degree, from the mild bronchial catarrh of the period ol 
invasion, to the hypostatic congestion which is apt to In- 
caused by the patient lying too long in one position, or by 
an enfeebled heart during the final stages of the disc 
and to those cases beginning with a pneumonia wind 
completely dominates the scene at the outset of the atta. k. 



308 TREATMENT. 

that it not infrequently happens that no suspicion of the 
true character of the malady is awakened until the patient 
has passed beyond all human aid. There is no way to 
positively differentiate between true pneumonia and that 
pseudo-pneumonia resulting- from an invasion of the air 
passages by the bacillus typhosis in the absence of charac- 
teristic symptoms of typhoid fever. 

Therefore, there is but one safe therapeutic procedure 
in the incipient stage of pneumonia, viz., it should be treated 
as a case of typhoid fever. It will rarely be needful to 
resort to any other than these antiseptic medicaments, and 
then only such remedies should be given as are necessary 
to temporarily allay the cough, to make the patient more 
comfortable by relieving him of this irritating feature of the 
disease. Should it be proved that the Eberth bacillus is 
causing the mischief, and that the malady is only a variety 
of typhoid fever, the attack will be shortened, but the pros- 
pect of a rapid recovery would not be lessened by this 
treatment, even if true pneumonia be present. 

In addition to the various stimulating or anodyne expec- 
torants so valuable in certain pathological conditions of the 
air passages, one remedy, benzoyl-guaiacol, stands out as 
prominently useful in those cases in which the inflammation 
embraces the smaller ramifications of the bronchial tubes. 

The frequently occurring catarrhal bronchitis, the cere- 
bral symptoms, the paralysis, the chorea, the jaundice, and 
the muscular degeneration of the heart as shown by the en- 
feebled action of that organ, all being due to the presence 
in the system of the toxins of the disease, are most sci- 
entifically and satisfactorily treated by the antiseptic 
method already described for the original illness, and with 
the exception of minute doses of strychnia to strengthen 
the weakened heart, none of them need any other special 
medication. 



TREATMENT. ;iQ9 

One of the most troublesome symptoms — one too not 
wholly devoid of danger — is the venous thrombosis, usually 
affecting the veins of the lower extremities, and sometimes 
causing enormous swelling, generally of one, but sometimes 
of both legs, and extending from the toes to the hips, and 
even the body. This condition requires no special thera- 
peutic management, it being safer to leave the swelling un- 
disturbed for a time, rather than run the risk of detaching 
a portion of the thrombus and causing embolism of the 
pulmonary artery. Later this complication may be treated 
by hot fomentations, massage, and elevation of the member. 

A physician engaged in a large consultation practice, 
especially if called long distances, will not infrequently see 
for the first time patients ill with typhoid fever, with all of 
the characteristic symptoms shown in the previous case, but 
in an aggravated form. 

The patient has been ill fourteen to sixteen days or 
longer, his morning temperature is 104°, his evening tem- 
perature 105° or even higher. His pulse beats 130 times 
to the minute, is soft and sometimes dicrotic. He is de- 
lirious, picks at the bedclothes and at his own fingers. I [e 
evacuates his bowels and bladder involuntarily. His ab- 
domen is covered with rose spots and is very tender, and 
there is also much tympanitic distention. He has for sev- 
eral days had slight hemoptysis, and has had one or per- 
haps more intestinal haemorrhages. He has been treat* d 
"symptomatically" and "secundum artem." but unless the 
art be newly interpreted and a radical change in tin- 
treatment be inaugurated, the closing scene is not difficult 
to foresee, nor must we look far into the future to find it. 
What then is the consultant's first duty? To discontinue 
and abandon forever and at once the course of treatment 
which has brought the patient to his present precarious 



310 TREATMENT. 

state. To institute immediately efficacious antiseptic thera- 
peutics. The treatment must be varied somewhat from 
that advised on a preceding page. 

Begin with tablets of formula Nos. 1 and 2, giving a 
tablet of each every fifteen minutes until twelve tablets of 
each have been taken, then discontinue No. 1 and give 
No. 2 alone until the freer evacuations or the change in 
character of the stools and the loss of offensive odor show 
that some antiseptic effect has been obtained. They should 
now be continued at longer intervals and in varied periods 
according to the strength of the patient, who is already ex- 
hausted by the distressing and violent strain of the disease. 
Every precaution should be exerted to prevent farther low- 
ering of the vital forces by excessive and debilitating diar- 
rhoea, but the eliminative effect of the medicines should be 
obtained, and under no circumstances should any day be 
allowed to pass with less than two free evacuations of the 
bowels. A perfectly aseptic condition of the alimentary 
canal must be procured and maintained, but if very many 
tablets are administered, they should be discontinued for a 
day or two at a time, and a teaspoonful dose of a saturated 
solution of chlorate of potash exhibited at three hour inter- 
vals. Time is very precious just now, and as there is less 
fear of the interruption of the treatment by emesis, the 
capsules containing formula No. 3 should be commenced 
early in the treatment. 

They should be given every three hours until im- 
provement in the condition of the patient is manifested 
by a considerable amelioration in all symptoms, when the 
interval between the doses should be lengthened gradu- 
ally, but they should be continued three times a day until 
the temperature remains normal. 

The temperature, which prior to the eighth day of 



TREATMENT. ;U1 

the disease, was a symptom which gave little alarm, is 
now of the gravest consequence, and should be con- 
trolled by every legitimate means at the disposal of the 
physician in charge of the patient. 

The nurse should be directed to sponge the patient 
two or three times each day, or oftener if necessary. In 
extreme pyrexia, from five to twenty-five, or in an emer- 
gency, thirty minims of guaiacol absolute should be ap- 
plied to the abdomen, the entire surface of which should 
first be cleansed by using an alkaline wash (bicarbonate 
of soda). This remedy should be used with discretion, 
since its application has sometimes been followed b\ a 
sudden and alarming decline in temperature, and threat 
ened collapse. An embrocation of spiritus terebinthinae, 
aqua ammoniae, oleum eucalyptus and guaiacol should be 
rubbed gently upon the abdomen, and over the most 
seriously involved thoracic region. The nurse should 
be instructed to watch carefully for the slightest symptom 
of threatening bed sores, and on the first appearance oi 
redness of the skin over any prominent part of the body 
— especially of the hips — a piece of ordinary adhesive 
plaster, large enough to cover not only the reddened por- 
tion, but several inches around it should be applied at 
once. If this does not suffice, a ring cushion or a water 
bed may be called into requisition. 

The flagging heart should be sustained with strych- 
nine and possibly digitalis, though the Litter is oi 
doubtful utility and its use is not always devoid <>i 
danger. The cough and dyspnoea may sometimes b< 
relieved with Dover's powder and the excessive diarrhoea 
controlled with opium and camphor. Quinine as a toni< 
may now prove to be useful, and here if ever, am- 
monia and alcoholic stimulants find their appropr 
field. 



312 ' TREATMENT. 

The food should be made as nutritious and assimila- 
ble as possible ; milk should be peptonized ; meat juice, 
egg-nog, and other easily digested foods may be added 
to the milk diet, and in failing digestion or in ano- 
rexia stimulating or nutritious enemata should be given. 

Hopeless as seemed the condition of this patient 
when the antiseptic treatment was begun, he has sur- 
vived without material retrogression the first forty- 
eight hours after the consultant was called, and has 
apparently made some progress toward recovery, but 
there are still the accidents of haemorrhage and perfo- 
ration to be dreaded. Every other cause of death has 
been done away with, and the danger to the patient 
from these calamities has been reduced to the minimum 
by emptying and cleansing the alimentary canal, thus 
rendering the intestinal wounds sanable and reducing 
the tympanitic distention. 

From this point the treatment has been indicated, 
and all of the instructions previously given as to rest, 
etc., must be observed. It may be generally stated that 
every resource of nature, art and science that can di- 
rectly or indirectly minister to the patient's comfort, 
arrest waste, add to the strength, or in any way aid in 
the conservation of the vital forces, should be mustered 
into active service. Had this patient been left under the 
inexcusable "symptomatic treatment " a few days or pos- 
sibly but a few hours longer, the indications for treat- 
ment would have been the same, but the result would 
have been very different. Toxaemia and coma or pro- 
fuse haemorrhage or perforation and peritonitis would 
soon have closed the scene, or later exhaustion would 
have carried the patient beyond all human aid. 

From this careful administration of every kind of medicine 
that can aid in the abortion of typhoid fever — in slowly re- 



TREATMENT. 313 

storing the patient to health or even alleviating his condition 
—in which is given every dose required even to the limit of 
his utmost necessity, taking the most painstaking precautions 
to avoid even the improbable accidents — from all this the 
scientific treatment of the disease varies through every gra- 
dation down to the administration of a few tablets of formula 
No. 1, in cases that present symptoms so unpronouncedthat 
no diagnosis whatever could be predicated upon them. 

Had the treatment of the hypothetical case been com- 
menced two or three days earlier the same medicine would 
have been administered, and in exactly the same manner, 
but a very much less quantity of it would have been given 
and it would have been discontinued very much sooner.. 
The patient would not have been confined to bed so long 
and perhaps not at all. He would have been allowed to 
take such exercise as he desired, and if he felt well enough 
it would have been possible after the first week, and in many 
instances even during this period, for him to follow his usual 
avocation. He would have been permitted to eat solid food 
at all times, as soon as danger of necrosis of Peyer's glands 
could be excluded as a possible lesion. When his tempera- 
ture had become normal, he would have been well in all that 
the term implies. His mind would have been clear and vig- 
orous, his strength unimpaired. His appetite and digestion 
would have been in as good condition as before the attack. 
Every organ of the body would have been performing its 
proper functions in a normal manner and this too, with the 
loss of but a few days from his business or pleasure 

The warm advocacy of the "Brand method oftreatment 
by cold bathing" in this country by Wilson. Osier and other 
professors of note, have raised the bath from its legitimate 
place which it held at the close of the last century, as an ad- 
junct to the treatment— to a routine method of managing the 
disease. This method has become quite popular with some 



314 



TREA TMENT. 



physicians, and for it the most extravagant claims have been 
advanced by Brandt and others of his school. It is not be- 
lieved that it shortens the duration of the disease, and the 
last report of the German Hospital of Philadelphia, for the 
year 1894, giving a death rate of 16^ per cent (78 cases, 
with 13 deaths) is hardly calculated to encourage physicians 
to adopt a treatment which has been designated ■ ' brutal " 
by one of its most enthusiastic advocates. The Medical 
News of the 27th of July, 1895, page 109, says : "The 
German Hospital has been the home of the so-called 
cold water treatment in this country, and the beneficial 
results of the treatment in this institution in previous 
years have been largely quoted. The following table 
shows the number of cases of typhoid fever treated and 
the mortality from the year 1890, when the Brandt 
method was introduced: 



YEAR. 


NO. OF CASES 
TREATED. 


DEATHS. 


PER CENT. 


1890 


106 

116 

1\ 

n 

18 


5 

8 

3 

11 

13 


4.1 


1891 


6.9 


1892 


4.2 


1893 


14.8 


1894 , 


16.6 







In the Medical News of November 26, 1892, Dr. 
J. C. Wilson reported one series of 160 cases treated 
according to the method of Brand with eight deaths, or 
5 per cent ; and another series of sixty-six cases with 
four deaths, or 6 per cent. (These cases are included 
in the figures already given, though differently ar- 
ranged.) It would be interesting to determine what has 
caused this unfavorable increase in the mortality rate 
under the cold water treatment. As far as we can learn 
the methods have not been changed, and the disease in 



TREA TMENT. 



315 

The 



Philadelphia has not been especially virulent, 
death rate varies in different years. In the same hos- 
pital previous to 1890 the mortality varied from 11 to 
20 per cent. 

The Pennsylvania Hospital typhoid fever statistics 
are as follows : 



YEAR. 


NO. OF CASES 
TREATED. 


DEATHS. 


PER CENT. 


1890 


126 
144 
104 
94 
105 


22 
23 

10 

4 

14 


17.4 


1891 


16.0 


1892 


9.6 


1893 


4.2 


1894 


13.3 







The Presbyterian Hospital reports show the following 



YEAR. 


NO. OF CASES 
TREATED. 


DEATHS. 


PER CENT. 


1890 


17 

39 
83 
69 
80 


5 

5 

6 

12 

3 




1891 


12.8 


1892 


7.0 


1893 


17." 


1894 


3.7 




_ 



In the Pennsylvania and the Presbyterian Hospitals 
the Brandt method has been used in the majority of the 
cases during the last two years. There is some danger 
of such a method of treatment becoming routine, to the 
exclusion of all other treatment, and this is always to be 
guarded against. 

A death rate of 14.8 per cent in 1893 and L6# per 
cent in 1894, so much higher than during the previous 
years, may not fairly represent the treatment but it 
certainly fails to fulfill the promises so lavishly made for 
this method." 



TYPHOID FEVER IN CHILDREN. 

The impressionable, partially developed nervous or- 
ganism of the child — the great variety of diseases to 
which the nonimmune babe is susceptible* — the rapid 
metabolism of infantile life — all serve to render an exact 
diagnosis of typhoid fever in early stages of the malady 
in young children more difficult than in the adult. 

The onset of the disease is usually more sudden and 
the nervous symptoms are far more prominent ; vice 
versa, the intestinal lesions are milder, the inflammation 
of Peyer's glands takes place earlier, but more frequent- 
ly ends in resolution. On the other hand, the inflamma- 
tion invades a larger area, not being so well confined to 
Peyer's glands ; but these glands increase in size in the 
same manner by hyperplasia, through proliferation of 
the lymphoid cells. 

The tumefaction of the spleen is as constant and pro- 
portionally as great, and the symptom consequently 
possesses the same diagnostic value in the child as in 
the adult. 

Tympanitis and tenderness in the right iliac region 
are symptoms of great importance, and have been 
present in a very large majority of my cases. 

The gastrointestinal symptoms are sometimes lack- 
ing ; the bowels, especially in early stages of the dis- 

*Murchison reports eight cases in which the eruption of typhoid fever and 
that of scarlatina coexisted. Numerous observers have noted the coexistence of 
the former disease with rubeola and various other diseases of infantile as well as 

of adult life. 

316 



TYPHOID FEVER IN CHILDREN. 317 

ease, being- normal in condition or even constipated, 
while in other instances these symptoms are so pro- 
nounced that men of large experience have not infre- 
quently diagnosticated typhoid fever as gastroenteritis 
and even as "acute indigestion." 

Bronchial catarrh is almost as constant and as 
prominent as in rubeola, and often leads to fatal errors 
of diagnosis. So commonly is the cough connected 
with typhoid fever in children that its presence should 
always excite a suspicion as to the nature of the indis- 
position. Some observers have even proposed to in- 
clude the symptom in the nomenclature of the disease. 
Professor Woodbridge, of Williams College, says : "A 
more or less severe bronchitis with not infrequent en- 
largement of the bronchial glands, is fast gaining de- 
served recognition as one of the most frequent lesions.' 
Wilson says : " Slight bronchial catarrh can hardly be 
regarded as a complication, it is so much a part of the 
clinical history of the disease." Flint says : "A slight 
or moderate cough is almost invariably present." From 
Niemeyer I quote the following: "We find changes in 
the respiratory organs in all cases. The typhoid laryn- 
geal ulcer is not infrequently found. There arc alwaj 
signs of an extensive catarrh, even in the smallest bron- 
chi, marked by dark redness of the mucous membrane 
and scanty, tough secretions. The bronchial glands are 
swollen, vascular, and occasionally have a medullary ap- 
pearance such as we shall describe for the mesenteric 
glands." 

The foul odor of the breath and sordes often found 
on the lips and gums of the babe, with rhagades al a 
later period, are often the accompaniments oi 
nervous symptoms. 



318 TYPHOID FEVER IN CHILDREN. 

The appearance of the tongue is one of the most 
characteristic symptoms of typhoid fever in infants, and 
although the coating may vary much in thickness and 
even in color, and may be moist, or dry and fissured, 
the clean red margin, and especially the red triangle at 
its tip are so typical of this malady as to amount to a 
practically pathognomonic symptom. 

The babe and young child will plainly show by the 
movements of the head and hands that headache is 
present, and this symptom, usually prominent at the 
onset, is apt to increase as the malady progresses, and 
the babe will rotate its head from side to side and bur- 
row it into the pillow, and finally well-marked opisthot- 
onos may present itself. The eyes may become 
crossed or sightless, and deafness, total or partial, is 
not an uncommon occurrence ; and the delirium and 
insomnia may be extreme. But grave as these symp- 
toms are, it must be remembered that they result from 
no organic cerebral lesion, save in rare instances. 

The pulse is always more frequent, and often found 
very much accelerated even when the other symptoms 
do not appear to be especially grave. Dicrotism is 
very rare. 

Epistaxis is less constant in the child than in the 
adult. 

Vomiting is frequently a troublesome symptom, and 
may be controlled by a sinapism placed over the epi- 
gastrium. 

The chill at the onset of the disease is rare or 
rarely observed in children, but if accompanied by a 
rapid rise in temperature may be regarded as a serious 
symptom. 

Haemorrhage from the bowels during typhoid fever 
is rare in childhood. 



TYPHOID FEVER IN CHILDREN. 319 

Rose spots are usually an early but not a constant 
symptom in children. 

A child will as a rule lose appetite from the very 
onset of the disease, and this is one of the earliest 
conditions which may indicate ill health. 

The designation of "mild" or "severe" or "abor- 
tive " or " prolonged "or " malignant " attacks of typhoid 
fever in the adult or in the infant as "varieties of the 
disease" is certainly a misapplication of terms, due to a 
misapprehension of the etiology of the infection. There 
is and can be but one "variety " of typhoid fever (un- 
less the invasion of the lung by the bacillus typhosis 
may come under this head) although a partial immunity 
on the part of the patient or the quantity of poison in- 
gested, or perhaps other causes may influence the char- 
acter of the attack. 

As typhoid fever in children is produced by the 
same causes and is governed by the same laws, the 
general management of the disease should be the same 
as has been indicated already, modified, of course, by 
the age of the patient. 

Should the child be so ill that it is necessary to con 
fine it to one room, a selection should be made of one 
which is large, light and well ventilated, and all unnec- 
sary articles of furniture removed ; and the temperature 
of which should be kept at from 65° to 68°. It should 
be immaculately clean in all respects. Two beds an 
importance, one for the child and one for tin- nui 
The bed covering should be soft and warm, the linen 
frequentlv changed, as well as the wearing apparel ol 
the child,' if in the slightest degree soiled, and properly 
disinfected in a solution of the chlorides or subjected to 
a high degree of heat. (Above 248' I 



320 TYPHOID FEVER IN CHILDREN. 

The nurse should be intelligent, and competent to 
take charge of the patient under all circumstances. 
Her personal habits should be unexceptionable, and her 
clothing- of such material as can be consigned to the tub 
as occasions indicate. 

The child should be given a sponge bath when re- 
quired for cleanliness or for its soothing and refreshing 
influence. The bath should always be hot, indeed cold 
water (except as a drink) should have no place in the 
treatment of typhoid fever in children. 

We were taught of old to guard against intestinal 
peristalsis, fearing that it would increase the danger of 
haemorrhage and perforation, but now the more rational 
idea that all of the noxas and microbes and (if the dis- 
ease have progressed so far) the bloodclots and pus and 
foul gases and all excrementitious matter should be elim- 
inated, and that the first and most important step is to 
thoroughly asepticize the alimentary canal as one would 
an abscess, and by so doing rid it of the specific poison 
of the disease and all of the other morbid material and 
debris which may have been accumulated, and to do this 
by free catharsis and diuresis, thereby stimulating the 
circulation in the peripheral vessels of the intestines and 
overcoming the tendency to blood stasis. 

All this can be effectually done in older children with 
the tablets and soft capsules which I have advised in 
another portion of this book, administered a little less 
frequently in proportion to the age of the child, but in 
such doses and at such intervals as to secure the results 
sought to be obtained in the treatment of adults. 

In younger children my method of procedure is to 
begin the treatment with the following tablets, which are 
made soft and friable so that they may be easily crushed 



TYPHOID FEVER IN CHILDREN. 321 

or dissolved in a little milk, sweetened water or any 
agreeable vehicle or dropped into the mouth as a powder. 



Formula No. 4. 
Each tablet contains 
Podophyllum resin, fine pwd. . .-g^ gr. 

Murcurous chloride, mild ^ gr. 

Guaiacol carbonate ^ gr. 

Menthol ^ gr. 

Eucalyptol q. s. 



Formula No. 5. 
Each capsule contains 

Guaiacol carbonate y z gr . 

Thymol 3 s gr. 

Menthol tV gr. 

Eucalyptol 1 minim 

Olive oil a. s. 



I give to a child one year old, one, two, or three 
tablets, every hour or oftener. If the case present very 
severe symptoms the child will require larger doses. 

Ordinarily it is not necessary to push the remedies 
as heroically as in adults nor is it advisable to produce 
such free catharsis. Four or five free evacuations of the 
bowels daily is the utmost limit to which the laxative 
effect should be carried in very young children and even 
this number should be procured for two or three days 
only. Capsules of formula No. 5 should always be 
given every three hours for a day or two after having 
given No. 4 for three or four days and every dose of 
every sort of medicine should be washed down with as 
liberal draughts of distilled water as the child can be in- 
duced to drink. These directions apply, whether the 
condition of the bowels be normal, constipated or alarm- 
ingly diarrhceic. If the latter condition prevails and 
the temperature is still high, the indications for the ,u\ 
ministration of antiseptics are all the more urgent and 
they should be exhibited promptly and nothing should 
be given that could in any way interfere with tin ir action. 
As soon as sufficient laxative effect of the medication 
been produced, or if the bowels were already diarrh 
when the change in color or the absence of di ible 



322 TYPHOID FEVER IN CHILDREN. 

odor indicates that the antiseptic effect of the medicine 
has been obtained, smaller doses should be given at 
longer intervals until the condition has become normal. 

Sometimes it is necessary to give carbonate of gua- 
iacol more freely than could be done with Formula No. 
4. In such instances this remedy may be given alone 
or combined with eucalyptol and menthol, or guaiacol 
absolute may replace the guaiacol carbonate. 

If the temperature remain alarmingly high, despite 
the antiseptic treatment, the child may be sponged with 
hot or warm water and if necessary a few drops of 
guaiacol absolute and eucalyptol may be rubbed over 
the abdomen, carefully graduating the dose to such an 
amount as will reduce the temperature to from 101° to 
102° F., but never lower than the former register. The 
effect of the application is apparent for several hours, 
the patient being more easily affected by the second 
embrocation which should be less in quantity than the 
first, but this repetition is rarely necessary. 

I have never exceeded thirty drops of guaiacol and 
sixty drops of the eucalyptol as an external application 
on the adult and the dose for children should be rather 
smaller in proportion to age, although I have never seen 
any bad results following its use in either instance. The 
irritation of the skin is nil and the patient is not discom- 
moded by its use. When the continued high tempera- 
ture indicates the necessity for this application it should 
be used under the supervision of the medical attendant, 
a*s alarming depression is said to have been observed. 

The object sought to be accomplished by the various 
steps in treatment are first to asepticize the alimentary canal 
and dislodge and eliminate the germs that are found within 
its walls to reduce to a minimum the quantity of poison in 



DIET. 3,3 

the system by thoroughly flushing out the prima viae ; to de- 
stroy or neutralize the toxins of the disease ; to sustain the 
vital and resisting powers of the patient; to excite the liver, 
kidneys and stomach to healthy action. These results will 
manifest themselves by the arrest of the diarrhoea, the relief 
of the delirium and the insomnia ; and the abatement of the 
other nervous symptoms ; the mind will become clear and 
remain so throughout the illness ; all the abdominal 
tenderness and tympanites will disappear, the urine will 
become clear and lose all disagreeable odor ; the 
tongue will become moist, and its coating begin to clear away; 
the appetite will return ; the temperature will decline rapidly 
to nearly, if not quite normal ; the pulse will increase in 
strength and diminish in frequency ; the skin which may have 
had that typically, earthy pallor will take on a healthy color 
and tone ; the respirations will become of normal frequency, 
and the bronchial catarrh will end in early resolution, and by 
the end of the first week or ten days of the treatment the 
patient will have lost all appearance of the typhoid state, ami 
should begin to be quite cheerful and happy, having none 
of the fretfulness incident to the illness, and will be henceforth 
a very manageable invalid. 

Diet. — As typhoid fever patients have a peculiar and dis- 
tinctive patholysis, i. e. the inflammation and threatened 
ulceration of Peyer's glands and the small intestines - the 
toxic centers — a most important factor in the success <>! the 
treatment is the proper and scientific management oi the 
dietetics. 

Milk is the ideal food — mother's milk for the babi 
or cow's milk for the older child and adult ; it is easy <>f di- 
gestion, assimilable and the fat and sugar which it contains 
are well adapted to keep up the failing strength and supply 
the " waste of combustion " caused by the high fever. The 



324 DIET. 

feeding of typhoid fever patients, if treated intelligently from 
the onset of the disease by the method I have advised is not 
of so much importance or consequence as if the pathological 
process be allowed to go on to necrosis and ulceration of 
the intestines. The proper feeding of infants in health or in 
disease is always a problem of much scientific interest. How 
often we find that children or adults, who seem to possess 
an antimilk idiosyncracy, can take it without discomfort and 
with benefit if rendered faintly alkaline by the addition of a 
little limewater or soda-bicarbonate or peptonized. It has 
been found too that milk of cows fed on beets and certain 
kinds of grass (notably the blue-grass of Kentucky) is 
slightly alkaline. It would be well therefore for the phy- 
sician to ascertain that the milk that his patient is using is 
alkaline, and this is especially important in typhoid fever, in 
which the diet should always be liquids of the most assimi- 
lable sort and such as leave the least debris behind. The 
food in this malady should always be selected with a view of 
adding as much as possible to the total liquids taken into the 
system. In addition to milk, the diet may consist of toast 
water, an infusion of barley, or of rice, which is rich in starch 
of a very, digestible form, and oatmeal, which contains a 
large proportion of fats. Meat juice and jellies, jelly made 
of iceland moss or of apple are sometimes very valuable and 
grateful additions to the dietary. 

Egg albumen or the white of egg beaten with lemon 
juice and sugar, blancmange followed a little later by 
fish or shellfish and finally by roast beef and beefsteak, 
but these articles of diet must not be given indiscrimi- 
nately. If the medical attendant could always be cer- 
tain that he is aborting the disease without any serious 
intestinal lesion, the selection of the different kinds of 
food would indeed be a simple matter. 



RELAPSES. 

i 

The relapse is as a rule much more abrupt than the 
first attack, that is, the temperature rises quickly and the 
pulse is sooner accelerated, the rose spots come early 
and after aborted attacks of the disease the relapse is 
more obstinate and generally of longer duration than 
the primary attack. 

Relapses of typhoid fever should be treated as new 
attacks of the disease, and a little more energetically. 
As a relapse is a reinfection from within, it follows that 
its occurrence should be rare, because if the virus which 
caused the disease originally, has been destroyed there 
can be no resuscitation of it. However if the noxa has 
not been entirely neutralized and the patient remains 
under .the observation of his medical attendant, any 
slight elevation of the temperature, the return of the rash 
or gastrointestinal, or other symptoms which signify the 
reawakening of the malady, can be seen at once, and 
should be regarded as an indication for a return to the 
antiseptic medication. 

Of 110 cases of well-marked typhoid (ever I have 
had three relapses which were severe and resisted 
abortive treatment more obstinately than the original 
attack of the disease. All of them might have been | 
vented by sufficient caution, but each of the patients had 
been walking about or driving long distances and two "1 
them had passed from observation for several days.* 

*Since the above was written two of my cases have relapsed. 

325 



326 RELAPSES. 

Case No. 128. Alonzo O., residing in the adjoin- 
ing county (Trumbull) whose brother had died a few days 
before from typhoid fever under the "expectant plan of 
treatment." 

After making a diagnosis of typhoid fever, I told 
him to come to my office every day, which with two or 
three exceptions he did throughout both his primary at- 
tack and relapse. 

The former was severe and ended in a subnormal 
temperature about the tenth day, which remained at or 
below normal for ten days when a relapse occurred with 
a longer high temperature (but in other respects not so 
severe) but rather more obstinate than the original ill- 
ness. In this attack the temperature was below normal 
on the ninth day, went up to 100° on the thirteenth day 
and did not again touch normal till the sixteenth day. 
This rise in temperature took place during my absence 
in Detroit when the patient considered himself so far 
convalescent as not to require any more attention. 

Case No. 129. Austie O. (wife of Case 128. J 

This patient had been feeling miserably ill for ten 
days, but as her husband had not recovered from his ill- 
ness she did not pay proper attention to herself, imagining 
that she had taken a very severe cold and the aches and 
pains were "just rheumatism." I saw her first in the 
early morning of the 30th of August, after a drive 
of three miles to my house (it was not yet eight o'clock) 
I found her temperature 104 °. I told her to go home 
and to bed and that I would come out and see her that 
evening. She went home and washed all of the accumu- 
lated household and wearing apparel of the period of 
her husband's illness, which was not taken from the line 
till after dark of a cool late summer evening when the 



RELAPSES. 327 

dew and fog was so very disagreeable as to require a 
greatcoat for my drive to her home. I found her tem- 
perature 104.8° and pulse 140, and the attack promised 
to be very severe. From this it dropped to 100.4° on 
the morning of the 2d of September, at which time 
I gave her explicit directions in regard to the manage- 
ment of the medicines, directing her to call a physician 
if necessary and left to attend the meeting of the Missis- 
sippi Valley Medical Association at Detroit. 

Returning on the 6th of the month, I found that she 
had neglected to take the medicine as directed ; for she 
thought herself in no more need of especial attention 
than had been her husband, whom I had seen on the 
second or third day of his indisposition. Hence, ins; 
of finding her on the fair road toward perfect health, I 
found that the temperature had gone up to 104.8°, and 
on the evening of the 9th of September (eleventh day 
of treatment, eighteenth day of disease) to 105.8 , pulse 
112. I ordered a recumbent position to be maintained 
at ail times, forbidding her to rise at stool. This order 
was not obeyed, for each time she insisted on rising ; 
in fact, was very troublesome in this respect, which in- 
discretion resulted in a slight haemorrhage on the even- 
ing of the 14th. 

From this time she improved rapidly, the tempera- 
ture being normal two days later, and remaining tl 
(with the exception of one insignificant rise of less than 
a degree) till the 19th, when I saw her for the last time. 
She was directed to remain in bed for ten days, and tin- 
physician who was called during my absence in Chi< 
reported a normal temperature still on the !0th, 
which time she felt well and hungry, and i ould not un- 
derstand why she could not sit up and eat solid 



328 > RELAPSES. 

her husband had done. She continued to improve until 
the 22d, when her temperature had gone up to 100° F., 
pulse, 100 ; which was the beginning of the relapse 
which terminated fatally under the care of another phy- 
sician during my absence in Chicago, which I shall 
allow the doctor to describe in his own words. 

During the latter part of the primary attack of ty- 
phoid fever of Case No. 129, Austie O., her sixteen 
months' old babe, Case No. 130, Roy O., had a very 
severe attack of the disease. The morning temperature 
the first time I saw him (the 14th of September) was 
104.6° F., eveningtemperature 105° F. ; and it wentabove 
this point sometime each day for the five following days, 
the highest temperature being 106° F. on the fifth day 
of the disease, after which time the patient rapidly re- 
covered, being left in the care of another physician on 
the ninth day of the illness. Temperature 100° F., pulse 
100, which went to normal on the seventeenth day of 
treatment. 

The percentage of my cases of relapses (2.7 per cent) 
is lower than the lowest recorded per cent of the London 
Fever Hospital (3 per cent), and a very considerable 
improvement on that of the 229 cases treated by Osier 
in the Johns Hopkins Hospital (7.3 per cent), by the 
German observers, Leibermeister, in Basle, 8.6 per 
cent; Gerhardt, 6.3 per cent; Baumler, 11 per cent; 
Biermer, 3.3 per cent, and Hutchingson, 6.25 per cent. 

A relapse in the child is rarely seen. 

The rational inference would be that an aborted 
attack of typhoid fever would be more likely to be fol- 
lowed by relapses than one that had been allowed to 
run its ordinary course ; but this is not so, if the small 
number of my cases which I have quoted constitute a 
reliable criterion. 






COMPLICATIONS AND SEQUELS. 339 

Complications and Sequels — When typhoid fever is 
allowed to run an uninterrupted course for several weeks, 
its complications and sequelae are so serious, so grave and 
so numerous, and withal are responsible for so large a per- 
centage of deaths that physicians who have not had an un- 
usually low death rate, sometimes say that they never lost an 
"uncomplicated case of typhoid fever" — and to outline the 
exact treatment of each, would require a much larger volume 
than the one I am writing. Such a dissertation would more- 
over be out of place in this work, since the whole burden of 
my argument is — that the patient is but the container of a 
specific poison which destroyed and eliminated leaves every 
organ free to resume its normal functions — hence dangerous 
complications and sequelae should be rare indeed in properly 
managed cases of typhoid fever. 

One Complication — perforation, demands especial at- 
tention ; should this take place the object to be attained is to 
preclude the extravasation of the contents of the intestine in- 
to the peritoneal cavity. The indications are for the admin- 
istration of morphine hypodermatically and perfect and 
absolute rest secured at once. In case of severe inflammation 
a poultice or ice should be applied over the abdomen. It 
will sometimes happen thata physician, quite capable of pre- 
venting necrosis and ulceration of Peyer's glands, had In- 
treated his patient from the onset of the disease, will be 
called upon to assume the management of a case oi t\ phoid 
fever at too late a stage to prevent the intestinal lesions; 
but in ample time to place the alimentary canal in a perfectly 
aseptic and as far as possible in a healthy condition before 
perforation occurs. Under these circumstances the aid ol 
the surgeon should invariably be invoked, without 
time, since without operative interference death is practically 
inevitable, and especially since the aseptic condition of the 



330 COMPLICATIONS AND SEQUELS. 

bowel renders possible much better results from a surgical 
operation than have heretofore been obtained. 

Dr. B. Merrill Ricketts, in the Cincinnati Lancet Clinic of 
April 6, 1895, in his paper on "Typhoid Ulcer ; Perforation, 
operation, death," says: 

"The enfeebled condition at the time when the operation 
is most likely to occur, is no doubt one of the greatest factors 
in allowing these cases to die without surgical relief. But 
now that drainage of the peritoneal cavity has been established 
in so many conditions we are led to believe that it may be suc- 
cessfully done, even when indicated in typhoid fever of any 
degree, for surely recovery cannot be expected without it in 
cases of perforation, or where the peritonitis is the result of 
the extension of typhoid inflammation. Now that we have 
the report of nineteen cases operated upon, with four recov- 
eries, it seems that the operation is proven to be a rational 
one, and that the greatest step in advancing the treatment of 
this condition has been made. There does not seem to be 
any question as to the time to operate, so far,as has yet been 
determined. The abdomen should be opened as soon after 
the perforation as possible, or as soon as peritonitis, with or 
without pus is discovered, whether or not the patient has 
rallied from the shock, for no time should be lost in washing 
out the abdominal cavity, and closing the perforation in any 
case that may be necessary. Attention should at once be 
given to the collapsed condition of the patient, the injection 
of warm salt water into the rectum, the irrigation of the abdo- 
men with warm salt water or peroxide of hydrogen, the use 
of nitrate of strychnia, digitalis, nitro-glycerine, and, as Abbe 
suggests, "very warm saline infusion into the vein, of at 
least one pint." 

"The reports of Van Hook and Abbe are as follows 
(Medical Record, page 2, January 5, 1895.) 



CO MP LIC A TIONS AND SE Q UELjE. 331 

1884. Mikulicz, four cases, one recovery, though un- 
fortunately the diagnosis is doubtful. 

1885. Lucke, one case, resection, death. 

1886. Escher, one case, recovery, but the case is re- 
garded by Louis as one of appendicitis. 

1886. Greig Smith, one case, doubtful diagnosis, death. 

1886. Bartlett, one case, death. 

1887. - Bonticue, one case, death. 
1887. Morton, one case, death. 
1889. Bonticue, one case, death. 

1889. Senn, volvulus and perforation, one case, death. 
- 18S9. Hahn, two cases, death. 

1890. Kimura, one case, death. 

1890. Taylor, one case recovered. 

1891. Van Hook, three cases, two dead, one recovered. 
1894. Caley and Bland Sutton, one case, fatal. 

1894. H. Allington, one case, fatal. 

1894. Netschagaw, Medical News, December 1, 1894, 

page 609, one case, recovery. 

1894. Abbe, one case recovery. 

1894. Alezandroff, one case, death. 

1894. Dandridge, one case, recovery. 

1895. Ricketts, one case, death. 

" It is not necessary that a perforation should be found 
to verify the diagnosis of typhoid fever, especially when tin- 
appendix is found intact, and all the symptoms have verified 
the diagnosis. I fully agree with Van 1 look and Abbe that 
the diagnosis maybe doubtful where the appendix is involved 
or cannot be found, but where the patient 1 in 

competent hands and has had the usual symptom 
typhoid, and a sudden collapse occurs from the fifteenl 
the thirtieth day, I see no reason why doubt should - 
to the propriety of operative interference." 



332 COMPLICA TIONS AND SEQ UEL^.. 

This report does not offer much hope to the victims of 
perforation of the intestine and peritonitis. Fifteen deaths 
after nineteen operations (or, as is stated in a late issue of 
the British Medical Journal, twenty operations with one 
recovery) is a fearful percentage to face but the awful alter- 
native makes the procedure a legitimate one and in view of 
the consanescent condition in which the ulcers are placed 
by antiseptic treatment, future reports may be expected to 
present much more favorable statistics ; albeit the occasion 
for the operation will become more and more rare, as 
physicians learn to secure adequate results from general 
and intestinal antiseptics. 

Abdominal section and ligation of the bleeding artery 
has been advised in alarming intestinal haemorrhage, but 
this is an operation which, (when the haemorrhage has be- 
come copious enough to justify the procedure), must be 
performed under most inauspicious conditions, therefore 
cautious and wise physicians will prefer to treat the patient 
through this accident by the application of ice to the ab- 
domen and the administration of ergot to arrest the haem- 
orrhage, and strychnia and stimulants to sustain the heart's 
action and the strength of the patient during the period of 
depression, to the hazard of such desperate surgery. 

Another complication has recently come under my ob- 
servation, in which a celiotomy might have saved the life 
of the patient had it been possible to make an exact diag- 
nosis in time to operate successfully. This allusion is to the 
case of James K, (reported on page 152) in whom all ordi- 
nary dangers of long continued illness or a fatal termina- 
tion from typhoid fever had been averted, as was evidenced 
by the disappearance of all of the unpropitious symptoms — 
the tympanites, the pain and tenderness of the abdomen, 
the delirium ; by the tongue becoming moist and clean ; by 



COMPLICATIONS AND SEQUEL.-E. 333 

the rapidity of the decline of temperature; by the return of 
the appetite ; by the cheerful and happy state of the mind ; 
and anatomically and most conclusively, by the healthy 
granulating- condition of the ulcers of the ileum. (See 
colored plate No. 1, page 152). There is a marked contrast 
to be seen in the appearance of these lesions as compared 
with those which are represented on the colored plate No. 
2, (page 154). This illustration shows a section of the 
lower portion of the ileum of a patient in whom a post-mor- 
tem had been made at the Cook County Hospital, Chicago. 
The patient died very soon after having been admitted to 
the ward of the Hospital and nothing was known as to the 
previous treatment of the case, but such information as I 
have at my disposal was courteously furnished me by Dr. 
Oliver N. Huff, of Chicago, who also very kindly arranged 
to have the specimens photographed, that they might be 
placed here to show the phcegedenic and gangrenous ulcers 
in contrast to the beautifully healing ulcers exhibited in 
plate No 1. Had a celiotomy been performed and the in- 
vagination (shown on colored plate No. 3, page 159 ) been 
unsheathed, it might have saved the life of the patient. 

Pregnancy. — Complicating typhoid fever, should be 
referred to, not as indicating or demanding any special 
treatment, but as requiring an early and careful application 
of antiseptic medicine, the beneficial effects oi which are 
made manifest by the reports of all of the physicians who 
mention the subject. These gentlemen report more than 
50 per cent of their patients as having recovered and 
eventually giving birth to health)- children at full term, 
whereas a very general summing up of the data <>i th 
cases which have been treated by other methods, indii 
that an average of not less than seventy out of every hun 
dred women have miscarriages, and an abnormally 1 



334 COMPLICATIONS AND SEQUELS. 

per cent die. It should be observed therefore, that neither 
the coexistence of pregnancy nor Bright's disease with 
typhoid fever, contraindicates the use of antiseptic medicine ; 
nor do I know of any other complication or pathological 
condition which does so. 

Pregnant women should receive the most scrupulous 
care and attention from both physician and nurse ; the 
medicine should be given at regular intervals and care 
should be taken to confine its laxative effect within due 
bounds. These patients should be kept as nearly as 
possible in a state of absolute rest and their diet should 
be restricted to the most easily assimilated articles of 
liquid food, preferably milk which should be taken in 
sips and, if necessary, peptonized. 

Pneumo-Typhus. — One of the most perilous compli- 
cations of typhoid fever — it probably very rarely con- 
tinues more than a day or so as a true pneumo-typhus, 
dependent upon the invasion of the lung by the bacillus 
typhosis only. The pathogenic microbe of typhoid fever 
is early reinforced by other microorganisms, most 
frequently, perhaps, by the microccoccus pneumoniae 
crouposae. The imminence of the invasion of the lung 
by these marplots emphasizes the importance of treating 
this complication antiseptically, early and heroically. 

The nervous complications of typhoid fever are sup- 
posed to be caused by the absorption of the toxins of 
the disease into the system — toxaemia — but the well- 
known fact that the microorganisms have been found in 
all parts of the body, coupled with the suspicion that 
they may excite inflammations and abscesses, would ap- 
parently justify the conclusion that the so-called neu- 
roses of typhoid fever are sometimes due to the migra- 
tion of bacteria to the brain, sometimes to meningitis 



CO MP LIC A TIONS AND SE Q UELJ5. 3 3 5 

caused by their presence and sometimes to hemostasis, 
or blood clot, and pressure. Sometimes the onset of 
illness is so sudden as to make the symptoms closely 
simulate those of cerebro-spinal meningitis, and instances 
are known in which patients have been stricken down 
and have died within forty-eight hours of the inception of 
the disease, without having regained consciousness ; 
hence in those attacks of typhoid fever in which the ner- 
vous element predominates, as well as in those involving 
the lung, the patient should be more energetically treated 
than I have recommended in typical attacks of the disease. 
Instead of giving one tablet of Formula No. 1, it is advis- 
able that two or three tablets of No. 1 and one or two 
of No. 2 should be administered every fifteen min- 
utes until their effects are perceptible, and instead 
of waiting until the third or fourth day to begin 
capsules of Formula No. 3, they should be given at once 
(or as soon as the danger of causing nausea or vomiting 
is averted) and continued at two or three hour intervals, 
until some abatement of the alarming symptoms has been 
observed, after which the patient should be treated 
cording to the directions which have been given on a 
previous page for an uncomplicated case o\ typhoid 
fever. 

Closely allied to the complications of the nervous 
system and which are due, no doubt, in some measure, at 
least, to the same cause, are those which involve the eye 
and ear. Choroiditis, irido-cyclitis, congestion and 
inflammation of the conjunctiva-, opacity ol the cornea, 
the not infrequent supervention of cataract and Other 
anomalies of vision, should constitute a sufficient warn- 
ing to the physician to take especial care of the 
his patients during attacks of typhoid fever. 



336 CONCLUSION. 

Abscesses occasionally make their appearance dur- 
ing an attack of typhoid fever and they should always be 
freely opened. Tumefied and inflamed parotid glands 
especially, should be deeply incised, even though no fluc- 
tuation can be detected and though no pus be escaping 
by Steno's duct. The operation is almost invariably fol- 
lowed by diminished tumefaction and a lowered temper- 
ature, as well as by a general improvement in the condi- 
tion of the patient. 



CONCLUSION. 

To the medical profession is committed the Abor- 
tive Treatment of Typhoid Fever and with it Antiseptic 
Medicine — the most important subjects which this, the 
most learned of the professions, will ever be called upon 
to investigate and adjudicate. 

Prof. Da Costa said in one of his lectures "typhoid 
fever is the fever of this country ; yes, it is the fever of 
the whole world." 

" Of this life destroyer," Sir William Jenner said "I 
have never known a case of typhoid fever to be cut 
short by any remedial agent — that is, cured. The poison 
which causes any of the acute specific diseases (to 
which typhoid fever, as much as smallpox, belongs) hav- 
ing entered the system, all of the stages of the disease 
must, so far as we know, be passed through, before the 
patient can be well. The ordinary duration of a fully 
developed attack of typhoid fever is from twenty-eight 
to thirty days." 

These expressions of opinion were written in 1893, 
after more than half a century of special investigation 
of the subject in the best school for its practical study in 



CONCLUSION. 337 

the world — the Fever Hospitals of London — and his 
words are entitled to every possible consideration, espe- 
cially as he voices the sentiment of his coadjutors on 
this side of the ocean, and they might well cause the 
boldest observer to hesitate on the eve of sending out 
to his profession, a book which promulgates theories 
which are in such direct conflict with those that are uni- 
versally taught, that its teachings must subvert those in 
conflict with it or consign its author to dishonor or 
oblivion, but I am writing from knowledge which is 
grounded on twenty years of personal experience sup- 
plemented by the reports of a large number of cases of 
typhoid fever, which have been aborted by this special 
method of treatment, and which were kindly sent me by 
an enormous number of physicians to support my as- 
sumptions, and the analysis and synthesis of these con- 
stitute irrefragable proof that my postulate is an estab- 
lished fact and they should remove the whole subject 
from the sea of speculation and theory, to the solid foun- 
dation of applied science. 

For this disease, at least, antiseptic medicine has 
passed out of the field of experimental study and it will, 
in the hands of those who understand its use and value, 
and who wisely select and dexterously exhibit the rem 
edies which are to be applied, be found to be as potent 
for the cure of typhoid fever as are the antiperiodics for 

malaria. 

The full import of this statement will become appar- 
ent as soon as the symptomology of the prodromi 
of the disease has been amplified, and its apodeixis will 
come quickly if the promise of the possibility 
early bacteriological diagnosis made by the re 
Eisner's experiments, should be sustained by the touch 



338 CONCLUSION. 

stone of practical experience, or if some other pathog- 
nomonic symptom of the incubating disease should be 
discovered, by means of which a direct diagnosis in its 
inchoative period could be established, then the world 
will recognize the truth of my oft repeated declaration 
that typhoid fever can be aborted and death from the 
diseases always averted. 



INDEX. 



331 
256 
311 
330 
330 



15 



Abbe, Report on Perforation. . 

Abdomen, Condition of 

Guaiacol applied to 

Irrigation of the 

Condition in Perforation 

Abdominal Affection, Southwood 

Smith (1830) 

Abdominal Fever, Flint (18 52) 

American Writers 15 

Abdominal Pain, (Hutchinson on 

12) 233 

Abdomimal Tenderness, Murchi- 

son on. 11 

Abdominal Section 332 

Abdominal Typhus Autenreith, 

(1822) 15 

Abdominal Viscera. 295 

Abercrombie (1820) Entero-mesen- 

teric Fever 18 

Aborted Typhoid Fever 

207, 209, 213, 214 

Abortive Attack 293 

Abortive Treatment 114, 129 

Remedies for 132 

Harmlessness of 133 

Should be instituted early 70 

Averted all deaths for fourteen 

years 179, 203 

Advantages of, to humanity. . . 285 
Importance of early diagnosis 

in *• 

Endorsements of 48, 122, 127, 
144, 145, 146, 147, 161, 162, 
163, 164, 165, 166, 167, 168, 
184, 185, 186, 187, 188, 139, 
190, 191, 192, 193, 194, 195, 
196, 197, 198, 199, 200, 201, 202 

Abortive Type of Typhoid 209 

Acetic Acid ~* 7 

Acid, Carbonic : ^ ):> ' 

Picric 217 



131 



Acid, Sulphanilic 235 

Acidum, Sulphurosum 284 

Acid, Hydrochloric . 235 

Acute Indigestion, differential di- 
agnosis of 317 

Acute Mania, differential diagno- 
sis of 254 

Acute Phthisis pulmonalis, differ- 
ential diagnosis of 252 

Adhesive Plaster 311 

Age, influence of 23, 24 

Osier on , '2-i 

Agminated glands, Harley on. ..13, 14 

Ague, Quotidian, Amoeba of 844 

Tertian, Amoeba of 844 

Quartan, Amoeba of *. . '-' \4 

Air Passages, Bacillus Typhosis in. 806 
Albert, Prince, Report on Death of 259 

Albumen in Urine 

Alcohol in Abortive Treatment. . . . 890 

in Late Stages 811 

in Chezynsky's Formula for 

Dye 

Ammoniated 

Absolute 845 

Hydrochloric Acid 

Methylated 

as a Nervous Sedative 

Alexandroff, On Operation in I 

foration 

Alexifers 

Alexins, Protective 

Alexipharmacons 

Alison, (1844), Kntrr.tr. I 

latosa, Fever with Afiectiofl 
of Abdomen ; ■ 

Alkaline Milk 

Alkaline Stools 

Alkaline Wash 

Alkaline Solution 



340 



INDEX. 



Alleghany, Reports of Typhoid 

Fever in 278 

Allington, H. f On Operation in 

Perforation 331 

Alimentary Canal, Habitat of 

Bacillus Typhosis 40, 42 

Alvine Dejections, Microscopical 

Study of 223, 234 

Leeuwenhoeck on 223 

Disinfection of 283, 285 

Alum Hematoxylin 248 

American Medical Association, 

Journal of, Editorial in ... . 29 
Quotation from Article on ' 'Ty- 
phoid Fever in Children." 135 

Meeting in Milwaukee. . 29, 43 

Meeting in Washington 39 

Meeting in San Francisco. .71, 103 

Meeting in Baltimore 133, 178 

America, Importance of Antisep- 
tic Medicine to 65 

Amoeba of Malaria 243 

Ammonia 235, 311 

Salycil 19G 

Amsterdam, • Death Rate in 278 

Analine Dyes 245 

Anatomical Lesions 14 

Plate of 152, 154, 333 

Date of Appearance of 237 

Andral, (1823), Fievre Continue. . . 16 

Anodyne Expectorants 308 

Anorexia, (Harley on, 13) 256, 312 

Anti-milk Idiosyncrasy 324 

Antiperiodics in Malaria 337 

Antipyretics, Medicinal, Condemna- 
tion of 299 

Antiseptic Medicine 53, 60 

No Death During Antiseptic 

Treatment 113 

All Physicians will Use 114 

Many Types Yield to 130 

Has a Reserve Power for Good 179 

Value in Early Stages 181 

Application of, to the Cure of 

Microbic Diseases 210,218 

Usefulness of 214 



Antiseptic Medicine, Condition of 

patient after 217 

Lower Death Rate After 218 

Resistance of Typhoid to 219 

As a Prophylactic 284 

As a Neutralizer and Elimi- 

native 292 

Professor L. D. Woodbridge, 

an Early Advocate of 300 

Directions for the Administra- 

iton of 302 

Cathartic and Antiseptic Ac- 
tion of 304 

Usefulness in Renal Complica- 
tions 306 

Treatment of Pneumonia with 308 
Various Complications Treated 

with 308 

Administration in Late Stages. 310 

Administration to the Child. . . 320 

Relapses Treated Energetically 325 

Apparatus for Microscopical Work 245 

Appetite in Children 319 

Appius Claudius 280 

Apyrexia 230 

Aqua Ammonia 31 1 

Aqueducts 281 

Croton 282 

Armstrong (1816), Common Con- 
tinued Fever 16 

Artery, Pulmonary 309 

Bleeding, Ligation of... 332 

Ashpits •. . 268 

Athens, Water Supply of 280 

Atypical Typhoid, Differential 

Diagnosis of 254 

Autenreith (1822), Abdominal Ty- 
phus 15 

Autopsy, After Error in Diagnosis. 136 
in Dr. Cunningham's Case. . . . 154 

in Dr. Dodge's Case 183 

Osier on , 75 

Babbington (1853), Febris Tym- 

panica 18 

Bacillus Coli Communis, first de- 
scribed by Escherish 224 



INDEX. 



341 



Bacillus Coli Communis, Pathogno- 
monic Signs of 225 

Virulized, as a cause of Ty- 
phoid 292 

Bacillus Tuberculosis, Microscopi- 
cal examination of the sputa 

for 252 

Bacillus Typhosis, Typhoid Fever 

due to 14 

Discovery of the, by Eberth 

and Koch 84, 224 

1 As a Cause of Typhoid Fever 224 
Same as the Bacillus Coli 

Communis, virulized 225 

in the Urine 235 

Pathological changes called 
Typhoid Fever, primarily 

due to 241 

Presence in the System of . . . . 292 
Invasion of the Air Passages 

by the 308 

Invasion of the Lung by the. . 319 

Bacteria 92 

Destruction of 219 

Ptomaines of ". 92 

Bacteriology, Wonderful Discover- 
ies in 14, 64 

Knowledge of, too new 91 

Giant Strides in the Science of 223 

in Microbic fields 224 

Indebtedness to 225 

in Diagnosis 241 

Bacteriological Demonstration 2G9 

Baglivi (1696), Febris Mesenter- 

ica Maligna 1? 

Ballonius (1680), Febris Gas- 

trica *« 

Balmer, Dr. Report of cases, from 

letter 100 

Balsam, Canada 248 

Baltimore, Meeting of American 

Medical Association at . . 13:5, 178 

Health Reports of 275 

Death Reports of 275 

Papers Read at, in the Section 



on Diseases of Children, 

May, 1S95 133 

Baltimore, in The Section on Prac- 
tice, May, 1895 178 

Barley, Infusion of 324 

Barnes, Dr., Verification of Diag- 
nosis 63 

Bartlett, (1842), Typhoid Fever.. . 15 
on Operation in Perforation 331 
Bath, American Medical Journal 

on 30, 35 

in Children, when Tempera- 
ture remains high 95 

Advocates of 104 

No Routinism in 296 

in Children 320 

Brand Method of 298 

Advocacy of Wilson, Osier, 

etc., of 313 

Baumler, On Percentage of Re- 
lapses 328 

Bay Head, New Jersey, Epidemic 

of Typhoid Fever at 2^ 

Bed Sores 

Treatment of 311 

Beefsteak 

Beets, Cows Fed on 

Belfast, Ireland, Epidemic of Ty- 
phoid Fever at. ... 

Benelli (1775), Febbre Biliosa. . . . 17 
Bengal, India, Water Supply of... 
Bennett, Dr., Report of Cases. l'Jl>. 194 

Benzoic Acid 

Benzoyl Guaiacol 

Berlin, Death Rate in 

Bertlotte, Dr 

Bicarbonate of Soda 

in Milk 

Biermeron Percentages I 

Bignami, Laveran's I I Ver- 
ified by 

••The Parasites ol Malarial 
Fevers," by. . . 
Bilio-Gastric 1 

Bilious Attack 

Differential DiaglK 



342 



INDEX 



Bilious Continued Fever, Modern 

Writers 17 

Bilious Fever, Pringle (1750), Rutty 

(1770) 17 

Bladder, Recumbent Position to 

Evacuate the 301 

Blanc Mange 324 

Blaxal, Dr., Report of Case 27 

Bleeding Artery, Ligation of 332 

Blood, Microscopical Examination 

of 223 

Blue Grass, Cows Fed on 324 

Body and Bed Linen, Disinfection 

of 284 

Clean and Spotless 296 

Warm and Light 296, 319 

Bonticue, On Operation in Perfo- 
ration 331 

Boston, Death Rate in 279 

Bouchard, Professor, On Abortion 

of Typhoid Fever 206 

Boudet, On Haemorrhage 236 

Bowels, Condition of, by Boudet. . 236 
In Early Stages 316 

Brain Fever, Osier on 75 

Differential Diagnosis of. . 142, 148 

Brand Method 298 

Of Reducing the Temperature 298 
Advocated by Osier, Wilson, 

etc 313 

Cases Reported Treated by, in 
German Hospital, Philadel- 
phia, Penn 314 

Breslau, Death Rate in 278 

Bretonneau (1826) Dothien Enter- 

ite 18 

Brewer, Dr. J. J . , Cases of Ty- 
phoid Fever Treated by 190 

Brieger, On Isolation of Typho- 

toxin 224 

Bright's Disease 130 

Complicated with Typhoid 
Fever 334 

Bright, (1829) Fever with Ulcera- 
tion of the Intestines 18 

British Medical Association 289 



British Medical Journal, "Water- 
Borne Typhoid," Reports on 

24, 25 

On Importance of Pure Water 266 

Bromidia 187 

Bronchial Catarrh, and Hypostatic 

Congestion 307 

Professor Woodbridge on 317 

Bronchial Tubes, Affection of ... . 308 

Bronchitis, Catarrhal 308 

Wyeth's, Tablets 89 

Wilson on 317 

Flint on 317 

Niemeyer on 317 

Broussais (1816), Gastro-enterite. . 18 
Brown, (1853), Night Soil Fever. . . 18 
Brown, Dr., Illness of the Prince 

Consort 268 

Brussels, Death Rate in 278 

Browitz, Microscopical Work of.. 224 
Burchard, Febris, Mesenterica 

Acuta 17 

Buccal Cavity, Microscopical Study 

of 223 

Buda-Pesth, Death Rate in 278 

Budd, W. (1856), Intestinal Fever, 

Theory of 18 

Buffalo Medical Club, Paper Read 

at 80 

Reference to Discussion in . . . 107 
Burt, Dr. C. I., Report of Cases. . . 197 

Caley, on Operation in Perforation 331 

Calomel 65, 191 

Condemnation of, by Harley.. 211 
Camphor and Opium, Diarrhoea 

Controlled by 311 

"Can Typhoid Fever be Aborted ?" 
Paper read, M. V. M. A., 

Oct. 1893 29 

Paper read, Mahoning Co., 

Jan. 1894 54 

Paper read, Mahoning County 

Medical Society, Feb'y, 1894 63 
Paper read, Ohio State Medi- 
cal Society, May, 1895 ...*.. 149 



INDEX. 



343 



Canada, Health Department of 41 

Canada Balsam 248 

Canadians, Importance of Abortive 

Treatment to 65 

Canton, Ohio, Letter from 166 

Capsules, Formula No. 3 305 

Formula No. 5 321 

Carbonic Acid Gas 303 

Cardiac Pathology 262 

Casts, in Urine 306 

Castor Oil 191 

Catarrh, Bronchial, Antiseptic 
Medicine, Best Initial Treat- 
ment for 307 

VonGeitl on ; ... 13 

Catharsis, Free, Dr. Dodge on. . . . 183 

Cathartics, in Diarrhoea. . . 300 

Mild Saline 306 

Condemnation of 210 

Causes of Typhoid Fever, Predis- 
posing 23 

Age 23 

Poisonous Effluvia 25 

Human Excrement 25 

Open Sewers 25 

Exciting, Bacillus Typhosis. . . 25 
Previous Attacks, Causing Im- 
munity 25 

Caecum, Glands of 14 

Cell Development 223 

Metamorphosis 223 

Celli, on Malaria 242 

Celiotomy 332 

Cemeteries, Drainage from, Prof. 

Prestwick on 289 

Cerebro Spinal Meningitis, Osier 

on r >° 

Differential Diagnosis of . .137, 254 

Inaccurate Diagnosis of 148 

Treated with the Sulphites 210 

Antiseptic Treatment of. 300, 308 
Cesspool Fever, Various Writers. . 18 

Cesspools, Illconstructed '- ),;x 

Chairman of the Ways and Means 

Committee, Illness of 261 

Chalandri, Ancient Airshafts to 



Aqueducts, at 280 

Chamber of Commerce 100 

Chemical Analysis 306 

Cheyne (1833), Epidemic Gastric 

Fever 17 

Chezynsky, Formula for Dyes. .. . 245 

Children, Typhoid Fever in 23 

"Children, Typhoid Fever in," 
Paper on, read before A. M. 
A., at Baltimore, May, 1895. 133 

Murchison on 134 

No Mention of, in Reynolds' 
" System of Medicine"... 134 

Pepper on 134 

Osier on 134 

Predominance of Nervous 

Symptoms in 135 

Quotation from A. M. A. Jour- 
nal on 135 

Post-mortems in 185 

Reports of Cases. ...186, 138, 
Differential Diagnosis in 

136,137, 148 

Limited Number of Cases Re- 
ported as 187 

Last Two Fatal Cases in I N 

Dr. McWilliams' Case 146 

Dr. Cunningham's Case 146 

Dr. Udell's Cases 146 

Results Predicted for Antisep- 
tic Treatment in 117 

Treatment in* 316, 8» 

Symptoms in 

Cough Connected with 

Dicrotism of Pulse Rare in . 
Chill Rarely Observed in. 

Hemorrhage Rare in 

Management of 

Tablets of Formu! 
Capsules of Formal 
Carbonate of Gnaitcol I 
Cainiacol and I 

plied to .' 
Milk, Cow's nr r.... 

Chilliness, Mur< 1 .11 

Hutchinson on 



344 



INDEX. 



Chlorate of Potash, Saturated So- 
lution of 305, 310 

Chlorinum 284 

Cholera, Differential Diagnosis of. 101 
Cholera Infantum, Mistaken Diag- 
nosis of . 137 

Treated as Typhoid Fever. . . . 148 
Chomel (1834), Fievre Typhoide. . . 15 

Chorea 308 

Choroid, Tubercle of 252 

Christiana, Death Rate in 278 

Christison (1840), Dothienenterite 16 
Chritzman, Dr. H. G., Report of 

Cases from Letter 188 

Cincinnati Lancet Clinic, Report 
of Death Rate in Foreign 

Cities, from 277 

Report of Ricketts on Typhoid 

Ulcer, from 330 

Cincinnati, Death Rate of 279 

Clark, Alonzo 255 

Clark, Sir James, on Illness of the 

Prince Consort 260, 261 

Cleanliness 267, 269 

Cleveland, Microscopical Work in . 223 

Cleveland Medical Society 157 

Clinical Record, Importance of . . . 297 
Clinical Society of Great Britain, 

Conclusions of 26 

Report on Infectiousness of 

Typhoid Fever 285 

Lectures * 220 

Coal Tar Derivatives 104, 120 

Condemnation of 67 

Dr. Shields on 197 

Heart Failure From 240 

As Antipyretics 299 

Collamore, Dr. Remarks at Colum- 
bus 107 

Collapse 319 

College of Physicians of London, 
England, (1869) Enteric 

Fever 15 

Colon, Glands of the 14 

Coma, Malaria with 249 

In Hypothetical Case 257 



Coma, During Symptomatic Treat- 
ment , 312 

Common Continued Fever, Arm- 
strong (1816) 16 

Complications of Typhoid Fever. . 14 

Air Passages 308 

Bedsores 257, 311 

Brain Fever 75, 142, 148 

Catarrh 92, 307 

Bowel 256 

Bronchial Catarrh... 307, 308, 317 

Cerebral 38 

Chorea 308 

Cough 89, 308, 317 

Delirium. . .213, 217, 241, 254, 257 
Diarrhoea 

....213,254, 256, 257, 300, 304 
Diphtheria, 72, 131, 148, 218, 300 

Dyspnoea 311 

Embolism of the Pulmonary 

Artery 309 

Enfeebled Heart 307 

Headache 238, 256 

Heart, Enfeebled 307 

Flagging 311 

" Muscular Degeneration of 308 

Hebetude 241 

Hemorrhage 76 

130, 140, 181, 198, 217, 235, 307 
Hypostatic Congestion of the 

Lungs 307 

Influenza, 72, 130, 151, 152, 210, 253 

Insanity 254 

Intussusception 154 

Jaundice 308 

Kidney 234, 306 

La Grippe 

72, 130, 151, 152, 218, 253 

Lung 307 

Mania, Acute 254 

Meningitis 

Meteorism 213, 217, 233, 256 

Opisthotonos 138, 317 

Paralysis 33, 68 

Pelvic 130 



INDEX. 



345 



Complications of Perforation 

47,131, 217, 256, 257, 

Peritonitis 

Phthisis Pulminaris, Acute.. . . 

Pneumonia 72, 

88, 131, 137, 151, 218, 307, 

Pneumo Typhus 253, 

Pregnancy 

Ptyalism 

Pyaemia 

Pyrexia 

Renal 235, 

Retching 

Spleen, 75. 88, 99,(217, 219, 234, 
Swelling of the Legs, Toes and 

Body 

Rubiola 300, 

Thrombosis, Detaching of . . . . 

Tympanitis 233, 213, 217, 

Urine '.234, 

Venous Thrombosis 

" by Harley. . 

" " by von Geitl 

" Cause of. ... 

AGravel30, 

Concentrated, Solution of Methy 

lene Blue, 

Conclusions of the Clinical Society 

of Great Britain, (1892) 

Condition of Patient at Onset of 
Disease, by Murchison.. . . 

Cone, Dr. J. E 107, 

Congestive Fever Certified as 

Cause of Death 

Congestion of the Capillaries 

Congress, the Duty of 

Consultant's Duty 

Contagious Diseases 

Contagiousness of Typhoid Fever 

by Bretanneau 

by Budd 

by Leuret 

by Gendron 

Control of Symptoms, A. M. A. 

Journal on 

Convalescence 



307 
257 
252 

308 
335 
334 
305 
252 
311 
306 
240 
257 

309 

317 

309 

236 

256 

309 

13 

13 

14 

241 

245 

26 

11 
150 

135 

236 
273 
309 
283 

290 
290 
290 
290 

30 
12 



Conveying Typhoid to Others. .2 
Cook County Hospital, Death and 

Post-Mortem at 144, 151 

Copenhagen, Death Rate in 278 

Copland (1844), Bilio-gastric Fev- 
er, Mild Typhoid Fever, 
Mucus Fever, Pituitous 

Fever 17 

Coperas 284 

Corrosive Poisons, as Microbicides 299 

Corrosive Sublimate 120 

as Cause of Death 

as a Disinfectant 

as a Microbicide 

Cos, Island of, Water Supply of. . 280 
Cost of Typhoid Fever, Dr. Osier's 

Estimate, 275 

Dr. Moore's Estimate 275 

in Chicago 

in Great Britain 'JT7 

in Scotland 27*3 

of Treating 187 

Costiveness 805 

Cough, Treatment of 89, » 

A Usual Complication 

Cow's Milk, the Ideal Food 

Laws of the Roman Syndic in 

Regard to 

Cows, Feeding of, on Beets 

on Blue Grass 

Craigie (1S37), Gastric Fever. Gas- 
tro-enteric Fi tro- 

Splenic Fever 9 

"Creameries and Infectious 1 

eases" 

Crematories, Garbage 

for the Dead from C 

Diseases 

Creosote 

Displacement 
Crescent Shaped Boi" us- 

tr.il Blood.. . 
Crnveilbier (l v 

culeuse 

Culh-n (1769), Entei 



346 



INDEX. 



tosa, Typhus Mitior, Syno- 

chus pro parte 15 

Cunningham, Dr. M. V., Diagnosis 

of 116 

Report of Case 14G 

Report of Fatal Case 151, 202 

Curability of Typhoid Fever, Evi- 
dence of the 33, 65, 101 

Cases Illustrating the 

35, 53, 59, 63, 77 

Declaration of 67 

Questioned, 30 30 

Curative Treatment of Typhoid 

Fever advantages of 39 

Curatoret Aquarum 281 

Dalton, Dr. H. C, Report of Cases. 200 
Dandridge, on Operation in Perfo- 
ration 331 

Dangerous Medicines, Withhold- 
ing of. 297 

Dangerous symptoms, Treating. . . . 298 
Darm Typhus, Autenreith (1822), . 15 

Deafness, Hutchinson on 12 

in Children 318 

Death, from Typhoid Fever Can 

Always be Averted 133 

Due to Corrosive Sublimate.. 219 
No Death in Thirteen Years. . 203 

Harley on 13 

Death Rate, from Typhoid Fever, 
Former, Under Symptomatic 

Treatment 113 

in Foreign Cities 278 

in Boston 279 

in Buffalo 90 

in Chicago 276 

Cincinnati 278, 279 

District of Columbia 279 

in German Hospital, Philadel- 
phia 314 

in London 278 

in Philadelphia 279 

in Pittsburg 65, 278 

in New Haven 74 

in Michigan 278 



Death in Scotland 277 

in St. Louis 90 

in United States 65, 114 

in Vienna 270 

in Youngstown 73 

Debility, Influence of 25 

Definitions of Typhoid Fever, by 

Murchison 11 

Hutchinson 12 

by Harley 12 

by von Geitl.... 13 

Hippocrates 18 

De Haen (1760), Miliary Fever. . . . 18 

Delirium, Murchison on 11 

Hutchinson on . , 12 

Journal of the A. M. A. on 30 

Minified by Abortive treatment 213 
Rambling, After symptomatic 

treatment 217 

as a Symptom 241 

in Hypothetical Cases 256, 257 

in Children 318 

Denver Medical Times, Quotation 

from Dr. Law's Paper. .... 192 
Department of Public Health of the 

United States 274 

Detroit, Mich., Paper Read, at, 222 

September, 1895 

Diagnosis, of Typhoid Fever, 227, 241 

Harley on Difficulty of. 13 

Confusion in, Caused by False 

Nomenclature 20 

For Treatment 73, 155 

Mistakes in 

74, 136, 137, 148, 241, 317 

Value of Symptoms in 75 

Tardy, Condemned 76 

Danger of Mistaken, of Ma- 
larial Fever. 77 

Condemnation of Composite. . 99 

Possible Error in 129 

Early, of First Importance . . . 131 
Early and Correct, in Chil- 
dren 134 

Report of Error of in, Journal 
of A. M. A 136 



INDEX. 



:;47 



Diagnosis, Made by Exclusion, 138, 

Correct 

Criticism of, by Members of M. 

V. M. A 

By Aid of the Microscope 

Exact, in Children, Difficult. . 

Dr. Gustavus Eliot on 

Difficulty of Taking Tempera- 
ture, Cause of Error 

Confirmed by Several Physi- 
cians 

Diazo Reaction as an Aid to. . 

Diaphoretic, Treatment 

Diarrhoea, Harley on 

Hutchinson on 

Murchison on 

in Diagnosis 

Ochre-Colored Stools 

Copious, as a Symptom 

An Indication for the Exhibi- 
tion of Laxatives 

Change in Character of. . .304, 

in Children 

Diazo Reaction, an Aid to Diag 

nosis 

Test 

Dickson, Dr. J. A. , Report of Cases. 

63, 

Dilated pupils, Murchison on 

Dicrotism, of the Pulse 

in Children 

Diet 

of Patients in the Buffalo Hos- 
pitals 

of Patients after Abortive 

Treatment 

No Restriction necessary in 
Aborted Cases of Typhoid, 

Fever 96, 99, 

Given at Proper Intervals. . . . 

Proper 

Directions for 

Journal of A. M. A. on 

Differential Diagnosis 1 ; 57, 

of Acute Mania 



242 
154 

222 

249 

316 

99 

232 

167 

234 

292 

13 

12 

11 

234 

256 

257 

300 
310 
321 

234 

235 

163 

11 

309 

318 

50 

82 

83 



130 
296 

312 

323 

80 



Differential Diagnosis of Atypical 

Typhoid 

Bilious Attack 

Cerebro-spinal Meningitis. . . . 

Epidemic Influenza 

Gastroenteritis 

Insanity 

La Grippe 

Malarial Fever 

Meningitis 

Pneumonia 

Pneumo-typhus 

Puerperal Fever 

Pyaemia 

Scarlatina 

Tuberculosis, Acute Phthisis 
Pulmonaris 

Tuberculosis, Miliary 

Tubercular Meningitis 

Typhus Fever 

by Murchison 

Digestion 

Digitalis 

in Perforation 

Diphtheria, Proper Treatment for 

73, 148 

Diuretic Mixture Given in Dr. 
Udell's Case 

Formula for 

Treatment 

Disinfectants, Proprietary 

Disinfecting Solution 

Disinfection, of Every Emunr: 

Not N fter Abor- 
tive ;it 

all Soiled Garment 

District of Colombia, I 
Typhoid Fever in . 

Death Rate in 

Distilled Water, witl >e of 

Medicine. . . 
Displaced by 1 

Dodg 



264 
254 

'.2.-> 4 

316 

•212 
253 



258 
248 

Bll 



348 



INDEX. 



Doses, Minute, of Antiseptic Medi- 
cine. . .111, 302, 303,305, 306, 302 
Dothienenterite, Bretenneau, 
(1826), Christison (1840), Leu- 
ret (1823) 17,18 

Dover's Powder 311 

Dresden, Death Rate in 278 

Dublin, Typhoid Fever in 277 

Death Rate in 278 

Durance River, Water Supply.... 282 

Duration of Typhoid Fever 103 

Murchison on 11 

Hutchinson on 12 

Harley on 12 

Sir William Jenner on 336 

Dyes, Dr. George Thin on 245 

Chezynsky's 245 

Mannaberg's 247 

Dyspnoea, Treatment of —311 

Ebel (1836), Typhus Gangliaris vel 

Entericus 15 

Eberth, Discovery of Bacillus Ty- 

phosis 83, 224 

Bacillus, Found in the Urine. . 235 
Bacillus Present in the System 292 

Edinburg, Death Rate in 278 

Editor of the Journal of the A. M. 
A., "On Treatment of Ty- 
phoid Fever" 64 

Editorial in Journal of A. M. A. . . 29 

Egg Albumen 324 

Eggnog 312 

White of 324 

Egopheny 163 

Ehrlich's, Diazo Reaction, in Diag- 
nosis ..169, 234 

Test 235 

Eliot Gustavus, Dr., on Incorrect 

Diagnosis of Typhoid Fever 73 

on Composite Diagnosis 99 

on Correct Diagnosis, Case of 

Dr. F Mahommed 262 

Emaciation 257 

Embolism of the Pulmonary 

Artery 309 



Embrocation of Guaiacol and Eu- 

calyptol 322 

of Spiritus Terebinthinae 311 

Emesis, Arrest of 280 

Empedocles 280 

Emulsion, Turpentine 163 

Endemic Disease, of Murchison. . . 11 

of Hutchinson 12 

Endemic Fever, Many Writers 15 

Enemata 312 

Enlargement of the Spleen, Dr. 

Eliot on 99 

Under Symptomatic Treat- 
ment 217 

A Symptom of Typhoid Fever 234 

Eosin, Solution of 245 

Enteric Fever. Ritchie (1846), 
Wood (1848), W. F. Gairdner 
(1859), Coll. Phys., London, 

(1869) 15 

Enterite-folliculeuse. Cruveilheir 

(1835), Forget (1841) 18 

Enterite Septicemique. Piory 

(1841) 16 

Enteritic Fever. (Mills 1813) 18 

Enteritis Erysipelatosa. Cull en 

(1769) 17 

Entero-Mesenteric Fever, Aber- 

crombie, (1820) 18 

Epidemic Gastric Fever, Cheyne • 

(1833) 17 

Epidemic Influenza, Differential 

Diagnosis of 253 

Epidemics of Typhoid Fever 24 

Bay Head, New Jersey 28 

Belfast, Ireland 286 

Buffalo 91 

Fortune's Well, England 27 

Ironwood, Michigan . 43 

Lake City, Iowa 197 

Leeds, England 286 

Lorain, Ohio 194 

Montclair, New Jersey 287 

New Melford, Connecticut 287 

North Dakota 91 

North Jackson, Ohio 38 



INDEX. 



349 



Epidemics of Typhoid Fever, 

Northern Michigan 91 

Orphan Asylum, England 25 

Plymouth, Connecticut 289 

Renfrew, England 275 

St. Louis 91 

Somerville, Massachusetts. . . 287 
Springfield, Massachusetts. . . . 287 

Stamford, Connecticut 287 

Wampum, Pennsylvania 36 

Waterbury, Connecticut 287 

Watertown, New York 289 

Winnifrede, West Virginia ... 289 

Epigastrium 318 

Sinapism Over 303 

Epistaxis 238, 252 

in Children 318 

Murchison on 11 

Hutchinson on 12 

Ergot in Haemorrhage 332 

Erysipelas 210 

Eruption of Variola 253 

"Eruptive and Continued Fevers," 
Death Rate in Dublin Hospi- 
tals 277 

Escher on Operation in Perforation 331 
Escherich First Described Bacil- 
lus Coli Communis 224 

Eucalyptol 65 

and Guaiacol Applied to the 

Abdomen 76, 322 

as Used by Dr. Dodge 183 

in Formula No. 1 302 

in Formula No. 2 303 

in Formula No. 3 805 

in Formula No. 4 321 

in Formula No. 5. . . . 321 

Eucalyptus. Oleum 311 

and Guaiacol, Applied to Ab- 
domen 311 

Eupalinus 279 

Evacuations, Disinfection of 

Number of 804 

in Children 321 

Evanson (1836), Infantile Remit- 
tent Fever 16 



Exciting Cause of Typhoid Fever. 

Invasion of the Noxa 25 

Excrementa, Rendered Innocuous 

by Abortive Treatment 42 

Disinfection of 284 

Exercise not Restricted in Abor- 
tive Treatment of Typhoid 

Fever 35, 95, 813, 217 

Exhaustion, Harley on 13 

Expectant Method of Treatment. . 258 

Expectorants, Anodyne 308 

Stimulating '. . 309 

Expectoration 163 

Eyes, in Brain Lesions of Children 318 
Ophthalmoscopical Examina- 
tion of 252 



Fasces, Microscopical Examination 

of 

Fairchild Brother and Foster's 

Panopeptin 

Fall Fever, Flint (1852) 

Farr (1859), Typhia 

Fatal Cases 183, 188, 185, 

in Consultation 

Last, from Typhoid Fever. . . . 

of Dr. Cunningham 

of Dr. Dodge 

of Boudet 

Faust, Denunciation of 

Febbre Biliosa, Bonelli (1775) ... 

Febricula, Manningham (1746) 

Febril Condition of Harley 

Febril Symptoms, Murchison on. , 

Hutchinson on 

G. Thin on 

Febris Acuta Stomachica, I 

Intestinalis, I 
Febris a Putredim rral- 

liani (1 : 
Febris Atacta, Pi 

(1770)... 
Febn 

(1638), Stahl 

(1786) 

Febi Putrid*, G 



888 

B09 

16 
18 

151 
189 
164 

17 
16 

12 
11 

i.; 
16 



350 



INDEX. 



Febris Chronica (?), Juncker (1736) 17 

Febris Colliquativa (?), Forestus 

(1668) 17 

Febris Colliquativa Primaria Sue 
Essentialis; Burserius, 
(1785) 17 

Febris Gastrica Ballonius, (1640) . . 17 

Febris Gastrica Acuta Burserius, 

(1785) 17 

Febris Glutinosa Gastrica, Sar- 

cone(1765) 17 

Febris Hectica, Willis (1667) 17 

Febris intestinalis Vel Mesenterica, 

Riedal, (1748) 17 

Febris Lenta, Forestus (1591), 
Willis (1659). Linnaeus 
(1763), Vogel (1765) 16 

Febris Mesaraica, Wendt (1822). . . 18 

Febris Mesenterica Acuta, Burch- 
ard, (1785), Burserius, 
(1785) 18 

Febris Mesenterica Maligna. 
Baglivi (1696), Hoffman 
(1699) 17 

Febris Mucosa. Selle (1770) 17 

Febris non Pestilens, Forestus 

(1591) 15 

Febris Petechizans vel spuria. Hoff- 
mann (1699) 17 

Febris Pituitosa. Stoll (1785). 
Strack(1789) 

Febris Pituitosa Mucosa, Jacobi, 

(1795) 17 

Febris Putrida. Riverius (1623). . 16 

Febris Putrida aut Nervosa. Wint- 

ringham (1732) 16 

Febris Putrida aut Biliosa. Tissot 

(1788) 16 

Febris Putrida quae vulgo lenta 

appellatur. Willis (1659) 16 

Febris Semitertiana seu compos- 
ita. Galen (?), Forestus 
(1591), Spigelius (1624) 16 

Febris Stercoralis (?). Quesnay 

(1753) 17 

Febris Tympanica. Babbington 



(1853) 18 

Febris Verminosa. Selle (1770). . 18 

Ferrum Sulphatum 284 

Fever on the Spirits. Manningham 

(1740) 16 

Fever, with Affection of the Abdo- 
men. Alison (1827) 18 

Fever, with Ulcerations of the In- 
testines. Bright (1829) 18 

Fievre Adena-Meningee. P i n e 1 

(1798) 16 

Fievre Continue. Lerminier (1823) 

Andral(1823) 16 

Fievre Ataxique, proparte. Pinel 

(1789) 16 

Fievre Entero-Mesenterique. Petit 

(1813). Serres (1813) 18 

Fievre Gastrique, Diet, des Sc. 

Med. (1816) *17 

Fievre Meningo-gastrique, Pinel 

(1798) 17 

Fievre Muqueuse, French Writers. 17 
Fievre Nerveuse, French Writers. 16 
Fievre Typhoide, Louis (1829), 
Chomel (1829), Bouchard 

(1895) 15 

Fischl 224 

Fish, as an Article of Diet 324 

Flagella in Palustral Blood 293 

Flagging Heart, Treatment of 311 

Flint (1852), Autumnal Fever, Fall 

Fever 15 

on Antidote to Typhoid Poison. 225 

on Arrest of Typhoid 226 

on Bronchial Catarrh 317 

Fomentations, hot 309 

Food 217 

Administration of. 296, 300 

Solid 313 

Liquid 307, 312 

Fordice (1791), Irregular Low Ner- 
vous Fever 16 

Forestus (1591), Febris Colliqua- 
tiva, Febris Lenta, Febris 
Non Pestilens, Febris Semi- 
tertiana seu Composita. .15, 19 



INDEX. 



351 



Forget (1841 ), Enterite-f olliculeuse. 18 

Formula, No. 1 302 

No. 2 303 

No. 3 305 

Diuretic Mixture 306 

No. 4 321 

Chezynsky's for Dyes 245 

Thin's 247, 248 

No. 5 321 

Diazo Reaction 235 

Fortune's Well, Epidemic at 27 

Fraser, Dr., Report of Case 124 

Free, Dr. S. M., Letter and Re- 
ports of Cases 190 

Friedlander 224 

Frontal Headache, in Diagnosis, . . 238 

Gaffky 22 

Gairdner, W. T., (1829) Enteric 

Fever 18 

Galen (?) Febris Biliosa 17 

Febris Semi Tertiana Seu 

Composita 16 

Ganges, Fresh Water Canal 282 

Gastric Derangement, Hutchinson. 12 
Gastric Fever, Craigie (1837). . .17, 261 
Gastrisches Fieber, Richter (1818). 17 
Gastro-bilious Fever, Modern Writ- 
ers , 17 

Gastro-enteric Fever, Craigie(1837) 18 
Gastro-enterite, Broussais (1816).. . 18 
Gastro-enteritis, Differential Diag- 
nosis of 317 

Gastro-intestinal Antisepsis 40 

Gastro-intestinal Symptoms 316 

in Relapse 325 

Gastro-splenic Fever, Craigie 

(1837) 18 

Gendron, Contagion Theory of... 290 
Geographical Distribution of Ty- 
phoid Fever 21, 10:5 

Gerhart, Percentage of Relapses.. 32S 
German Hospital, of Philadelphia, 

Brand Method in 814 

German Observers on Relapses. . . 328 

Germicides, Nontoxic 219 

Gibson, Dr. R. D 



Gilchrist, (1734), Nervous Fever. ... 16 

Glasgow, Death Rate in 278 

Goat's Milk 323 

Golgi 242, 249 

Grass, Blue for Cows 324 

Great Britain, Typhoid Fever in. . 277 

Greeks, Health etc 279 

Griesinger (1857) Ilio-Typhus, . . . 15 

Guaiacol 65 

Applied to Abdomen 7''' 

and Eucalyptol Mixture 183 

Replaced by Carbonate of . . . . 210 
Absolute, External Applica- 
tion of 311, 322 

Benzoyl, in Lung Complica- 
tions 308 

Embrocation of 822 

Carbonate of, Report of Dr. 

Law 1M 

in Formula No. 1 302 

in Formula No. 2 3^3 

in Formula No. 3 805 

in Formulae Nos., 4 and 5. . . . 821 

Gurgling, Murchison on 11 

as a Symptom of Typhoid 

Fever 266 

in Diagnosis 

Guy's Hospital 862 

Hematoxylin for Staining Spon 

Hahn, Dr. H. H 

Verification of Diagnosis . r >l 

Hahn on Operation in l'crforati 

Hamburg, Death Rate in 

Hamilton, John B , A M . M 

Report of Marine Hospital 

Service 

on Rose Spots 

on Typi) in Rural 

District 

Hare (1858), Sepimia ..16 

Harlem Viaduct 

Harley, Definition 

Fever 

Condemnation oi 
Catbarf 



352 



INDEX, 



Hart, Ernest, Mr., "Reports on 

Waterborne Typhoid " 24 

on Period of Incubation of Ty- 
phoid Fever , . . 26 

Duration of Power of Convey- 
ing Infection 27 

Modes of Convection 27 

on Prophylaxis 2G6 

on Polluted Wells and Streams 270 

on Contaminated Milk 285 

Headache 256 

Murchison on 11 

Hutchinson 12 

Louis on 238 

in Diagnosis, Occipital 238 

Frontal 238 

Health Boards of Canada 41 

of the United States 

Duty of 268, 272 

Limited Jurisdiction of. . .282, 283 
Health Reports as Evidence of Er- 
rors in Diagnosis 137 

Health Report of Typhoid Fever 

in Chicago 276 

in Dublin 8 

in the German Hospital, Phil- 
adelphia 314 

in Michigan 278 

in Mid-Renfrewshire 276 

in New Haven 74 

in Pennsylvania Hospital, 

Philadelphia 315 

in Philadelphia 275 

in Pittsburg 65, 278 

in the Presbyterian Hospital, 

Philadelphia . . . . 315 

in Scotland 277 

in Great Britain 277 

in Stamford, Connecticut 278 

in the United States 65 

in Youngstown, Ohio 73 

Heart, in Diagnosis 240 

Enfeebled. 307 

Flagging 311 

Muscular Degeneration of. . . 308 



Failure. Due to Coal Tar De- 

rivitives 240 

Hebetude, in Diagnosis 241, 954 

Hectic Fever, Harley on 13 

Heister (1736) Febris Acuta Stom- 

achica aut Intestinalis 17 

Hematozoa, Malariae, Action of 

Quinine on 219 

Laveran's Discovery of 223 

Valuable in Differential Diag- 
nosis 242 

Hemitritaeus 15 

Auctor. antiq. Var Galen (?).. 19 

Haemoptysis 309 

Haemorrhage 14 

Harley on 13 

Hutchinson on 12 

Murchison on 11 

Should be Unknown 66 

in Case No. 51 151 

From the Lungs 130 

Common in Cases Not Scien- 
tifically treated 211 

in Diagnosis 235 

and Perforation 307 

Accident to be Dreaded 312 

in Case No. 105. 140 

Rare in Children 318 

Danger of, Minimized 181 

Does Not Contra-indicate 

Abortive Treatment 198 

Danger of, Not Increased by 

Peristalsis 320 

Ergot in 332 

Ice in 332 

Hepatization 163 

History of Typhoid Fever . . 19 

Hoffman (1699) Febris Petechizans 
vel Spuria, Febris Mesenter- 

ica Maligna. 17 

Holland, Sir Henry, on the Illness 
of the Prince Consort, of 

England 261 

Holmes, Dr. O. W., on the Med- 
ical Profession 106 



INDEX. 



353 



Hospitals, for Clinical Teaching. . . 221 
Condition of Patients in Buf- 
falo 82 

Cook County ]44, 151 

German, Philadelphia . . 314 

Guy's, London 262 

Death Rate in 314 

Ironwood 45 

Memphis 196 

Pennsylvania, Philadelphia. . . 315 
Presbyterian, Philadelphia. ... 3io 
Saint Louis, Superintendent of 200 

Scotland 277 

Hot Springs, Paper, "Can Typhoid 
Fever be Aborted ?" Read 
November. 1894, Denuncia- 
tion at 222 

Huff, Dr. Oliver N., Photograph 

Supplied by 334 

Human Excrement 26, 269 

Poisonous Effluvia from, Pre- 
disposing Cause of Typhoid 

Fever 25 

in Drinking Water 267 

Hutchinson, Dr. James H., Defini- 
tion of Typhoid Fever 12 

on Diagnosis and Treatment. . 250 
on Percentage of Relapses. . . . 328 
Huxham, (1739) Slow Nervous 

Fever 16 

Hydrargyrum Chloridum Corrosi- 

vum 284 

Hydrochloric Acid 236 

Hydrogen, Peroxide of 330 

Hydrostatic Principle, Known to 

the Ancients 281 

Hygiene 

Hygienic Surroundings, Bad . .147, 18G 
Hyperesthesia in Reported Case. . 147 

Hyperplasia 316 

Hypostatic Congestion 307 

Hypothetical Case, Nursing and 

Treatment of. .301, 306, 309, 313 

in Children 828 

Murchison's 



Hysteric Fever, Manningham, 

(1746) .' 

Ice, in Perforation 

in Bleeding Artery 

Ileum, Necrosis of the glands of. 

Tumefaction of the glands of. 

Murchison on 

Hutchinson on 

Iliac fosae, Tenderness in 

in Diagnosis 

in Hypothetical Case 

Murchison on 

Hutchinson on , 

in Children 

Ilio-typhus, Griesinger (1857) 

Immunity from typhoid fever ac- 
quired 

children posess no special .... 

Incubator 

Incubation period of typhoid, 26, 27 
Incurability of typhoid fever, Jour- 
nal of the A. M. A., on. . . . 
Indigestion, differential diagnosis 

of 

Infantile Hectic Fever, Various 

writers 

Infantile Remittent Fever, Evan- 
son (1836), Maunsell (lfi 

many writers 

Infectious Diseases, Prophylaxis 



Infectious Fever, Hutchinson 

Influenza, treatment of 

Differential Diagnosis of 

Insanity, Differential Diagnosis of 

Insomnia 

Intestinal Derangement 
Intestinal Fever, W. Budd 
Intestinal Haemorrhage 

Harley on 

Hutchinson on 

Murchison on . 
Intestinal Pel 

Lesions, Date of h 
of 



16 
.329 

«aa 

14 

12 

12 

7.", 

233 

256 

11 

12 

316 

15 

23 

24 
2 46 
. 71 

17 



16 

19 
L8 

1 1 
18 

1 1 
n 



354 



INDEX. 



Intestines, Microscopical Examin- 
ation of 223 

Intoxications krankheit, von Geitl. 13 

Introduction 5 

Intussusception, Case of 159 

Anatomical Specimen 202 

Colored Plate of 159 

Iodine 210 

Ipecac 98 

Ironwood, Mich., Epidemic of 

Typhoid Fever at 43 

Irregular Low Nervous Fever, For- 

dice (1791) 16 

Island of Cos, Water Supply of. .. 280 
Island of Ortygia. Water Supply of 280 
Jacobi (1743) Febris Pituitosa Ner- 
vosa 17 

Jaundice 308 

Jellies, of Meat, Iceland Moss and 

Apples 2.34 

Jenner Sir William (1849) Typhoid 

Fever 15 

on the Incurability of Typhoid 

Fever 236 

on the Illness of the Prince 

Consort 260, 261 

Johns Hopkins' Hospital Reports, 

24, 104 

Relapses 328 

Juices, Lemon, Fruit, Meat 324 

Juncker (1736), Febris Chronica, 

Febris Biliosa 16 

Justice, Dr. R. C, Consultations 

with 122, 124 

Report of Case 162 

Endorsement of Abortive 
Treatment 163 

Kanz, Schieinfeiber (1795) 17 

Katzenback, Dr 28 

Report of Epidemic at Bay 

Head, New Jersey 286 

Kentucky Blue Grass, for Cows' 

Food 324 

Kidneys, Journal of the A. M. A. 

on Treatment of the 30 



Kidneys, Excretion of the 234 

Protection of 206 

Free Action of 35 

Microscopical Examination of. 323 
Kimura, on Operation in Perfora- 
tion 331 

Klebs 224 

Klein 224 

Koch, Discovered the Bacillus Ty- 

phosis 83, 224 

Koch— Eberth Bacillus 235 

Knaus, (1786) Morbis Biliosis Mu- 

cosus 17 

La grippe, Abortive Treatment for 

Typhoid Fever in 72 

Typhoid Fever Mistaken for 

151, 152 

Antiseptic Treatment for 218 

Differential Diagnosis of 253 

Lake City, Iowa, Epidemic at.... 197 
Lancet Clinic of Cincinnati, Re- 
port on Death Rates. 277 

Report of Ricketts on Typhoid 

Ulcer, etc 

Langrish (1735) Lent Fever 16 

Laryngeal Ulcer, Niemeyer on 317 

Lassitude, Hutchinson on 12 

Laveran, Exclusion of, hsematozoa, 

of 169 

Hasmatozoa, Sought for 223 

Discovery of 242 

Types of 243 

" Diagnostic Value of 249 

Law, Dr. G., Paper on Abortive 

Treatment of Typhoid 192 

Laxative Effect Important in Abor- 
tive Treatment 292, 300 

Professor L. D. Woodbridge 

on 300 

Leeds, England, Epidemic at 286 

Liebermeister, Percentage of Re- 
lapses. 328 

Lemon Juice 324 

Lent Fever, Strother (1729) 16 

Lerminier (1823), FieVre Continue. 16 
Lesions, of Typhoid Fever. ... 12 



INDEX. 






Lesions, Hutchinson on 12 

Harley on 12 

Anatomical 14 

Date of Appearance of 237 

Leucocytes, Pigmented 249 

Globules in 243 

Leuret (1823), Dothienenterito, of. 18 

Contagion Theory, of 290 

Leeuwenhoeck on Living Germs in 

Alvine Dejections 223 

" Life of the Prince Consort," 

Quotations from 261 

Ligation in Intestinal haemorrhage 324 

Linen, Disinfection of 284, 296 

Linnseus, (1763) Febris Lenta 16 

Little Fever, Manningham, (1746). 16 

Liverpool, Death Rate in 278 

Loch Katrine, Water Supply from. 282 

London, Death Rate in 278 

London Fever Hospital 251 

Relapses in 328 

Lorain, Ohio, Epidemic in 194 

Long Continued Case of Typhoid 

Fever, Report on 208 

Louis (1829), Fievre Typhoide 15 

on Rose Spots "....'...19, 228 

on Headache 238 

on Pulse 240 

on Operation in Perforation.. 331 

Low Fever, Many Writers 16, 260 

Lucke, Report on Operation in Per- 
foration 331 

Lung, Microscopical Examination 

of 22:? 

Complications 

Invasion of. ... :; 1 9 

Lymphoid Cells 816 

Magnesia 98 

Liquid Citrite of 

Sulphate 19 

Mahomed, Death of Dr. Frederick 

Mahoning County Medical Society, 

Taught Abortive Treatment 

in, in 1880 

Paper on Typhoid Fever 106 



Mahoning County Medical Soc: 
Members of, Endorsed Report 

inState Society 1*17 

Malarial Fever, Diagnosis of . . . . 
Confusion of, with Typhoid 

Fever, Deprecated 

Deaths from Typhoid Fever, 

Reported as 

Typhoid Fever, Mistaken foi . 
Danger of Mistaking Typhoid 

Fever for 

Typhoid Fever Charts 

taken for Charts of 

Dissimilarity of Thermic Lines 
of Typhoid Fever and Case^ 

No Death from 

Early Studies of 

Microscopic Diagnosis of . . . . 
Differential Diagnosis 01 

Dr. G. Thin 

Malarial Parasites, Laveran and 

Other Discoverers on 

Manchester, Water Supply of. . 

Death Rate in 

Mangetus, (1G9.'>) Tritaeophya 

phodes 16 

Mania.Differenti.il Di 
Mannaberg, Verification 
eran's Discovery I 
Method of Staining Malarial 

Parasites 

Manningham (174 

tie Fever, Nerv >a 1 1 ■■■ 

1 on 
the Spirits, V 16 

Manzini. 1 

March. Dr E, J 

an'i 

Mart:- '•• of 

the Prli 
Marseilles, V 

■' 
Massillon.O • 1*1 



356 



INDEX, 



Maunsell (1836), Infantile Remit- 
tent Fever 16 

McCandless, Dr. Guy, Health Re- 
ports of Pittsburg 278 

on Deaths from Typhoid Fever 278 

McCurdy, Dr. John 38, 55 

Endorsement of Abortive 

Treatment 160 

Cases Seen by 38 

McGarvey, Dr. J. F., Report of 

Cases 191 

McLeod, Dr 44 

Remarks of 45 

McWilliams, Dr., Report of Cases. 145 

Meat Juice 324 

Medical News, on the Brand 

Method 314 

Netschagaw on Operation and 

Perforation 331 

Medical Record, Report on Opera- 
tion in Perforation 330 

Medicaments, Great Variety of . . . . 85 

Mild and Gentle 133 

Medicinal and Antipyretics, Con- 
demnation of 299 

Megara, Water Supply in 280 

Memphis City Hospital 196 

Menthol, in Formula No. 1 302 

in Formula No 2 303 

in Formula No. 3 305 

in Formula No. 4 321 

in Formula No. 5 321 

Mercurous Chloride, Mild, in 

Formula No. 1 302 

in Formula No. 2 303 

in Formula No. 4 321 

Mesenteric Glands, Hutchinson on 12 

von Geitl 13 

Tumefied, Specimen of 202 

Mercurials, 111 Effects of 305 

Metabolism in Children 316 

Methylene Blue, Solution of, in 
Chezynsky's Formula for 

Dyes.. ., 245 

Meteorism 233 

Meyer, B 224 



Meyers, Dr. H K., Report of 

Cases 190 

Microbic Diseases 148 

Power of Antiseptic Medicine 

Over 157 

Application of Antiseptic Medi- 
cine to, Case of 210, 218 

Microbicide, Corrosive Sublimate 

as a 299 

Microorganisms 269 

Micrococcus Pneumoniae Crou- 

posae 335 

Microscope 306 

in Alvine Dejections, (1673), . . 223 

Examinations of Stools 234 

Valuable Aid in Diagnosis. . . . 235 
Examination of Blood for ma- 
larial Parasites 242 

in Diagnosis of Malaria 245 

in Diagnosis, by Dr. Thin. . . . 249 
Examination of Sputa, of 
Urine, of Buccal Cavity, of 

Fasces 223 

Necessary Outfit 244 

Mikulicz, Operation on Perforation 331 
Mild Typhoid Fever, Copland, 

(1844) 15 

Miliary Fever, Pringle, (1760), De 

Haen, (1760) 18 

Milan, Death Rate in 278 

Miliary Tuberculosis, Differential 

Diagnosis of 253 

Milk 26 

Contaminated 27, 86 

Katzenbach's Report on 28 

as a Nutriment 82 

from Unhealthy Cows 266 

Influence in Spreading Zymo- 
tic Diseases 285 

Boiling of 285, 286, 288 

Peptonized 312 

for the Babe 323 

Alkaline , 324 

Mills, (1813), Enteritic Fever... . 18 

Mind 313 

Mineral Water 191, 306 



INDEX. 



> I 



Mississippi Valley Medical Society 

Paper Read at, 1893 29, 55 

Discussion of Paper in 105, 200 

Paper Read at, (1894), Hot 

Springs, Arkansas 112 

Paper Read at, (1895), Detroit, 

Michigan 222 

Mississippi Valley 41 

Mitchell District Medical Society, 

Paper Written for, (1895), 

West Baden Mineral Springs 205 

Moore, Dr. J. W., Quotation from 

" Eruptive and Continued 

Fevers" 277 

Montclair, New Jersey, Epidemic 

at 287 

Morbus Biliosis-Mucosus, Knaus, 

(1786) 17 

Morphine. . m 329 

Morton on Operation in Perforation 331 

Moscow, Death Rate in 278 

Muco Enteritis, Various Writers. . 18 
Mucous Fever, Copland, (1844)... 17 

Munich, Death Rate in 278 

Munro, Dr., on Cost of Typhoid 

Fever 275 

Murchison, Definition of Typhoid 

Fever 11 

Nomenclature of Typhoid 

Fever 15 

Pythogenic Fever 18 

Report of Lesions in Seven 

Months' Foetus 23 

on Incubation of Typhoid 

Fever 26 

on Typhoid Fever in Children 

134, 310 

Chart of Wunderlich 210 

on Rose Spots 227, 228 

on Haemorrhage 236 

on Headache 238 

on Pulse 210 

on Contagion of Typhoid Fever 2!)0 
Murphy, Professor, Denies the Pos- 
sibility of Aborting Typhoid 
Fever 108 



Muscular Degeneration of the Heart 308 

Naphtha 245 

Nausea .21 

Harley on 18 

Necrosis 217 

Nephritic Derangement 228 

Nervenfieber, German Writers. ... ]>'•. 

Nervous Complications 335 

Nervous Fever, Gilchrist (1734). 

Manningham (1740) 16 

Nervous Sedative, Alcohol as a. . . . 300 
Netschagaw, Report of Case of Op- 
eration in Perforation I 

Neven, Dr. J. K., Health Officer of 
Ironwood, Endorsement of 

Treatment 4 s 

NewMilford, Connecticut, Epidem- 
ic of Typhoid Fever at 

New York Clinical Society, Katzen- 
back's Report of Epidemic at 

Bay Head to 

New Theory 4* 

New Sydenham Society 249 

Niemeyer on Bronchial Catarrh. 
Night Soil Fever, Brown (1856) . 18 

Nitrate of Sodium 888 

of Strychnia 

Nitro-Glycerin 

Nomenclature, from Murchison... 18 

Nontoxic Germicides 

Normal Temperaturr in RectDDO 

Noxa? 

North Dakota, Epidemic in. 
North Jackson, Ohio, Epidemic h 
Northern Michigan, 1 

Nurses 

from Royal Inf: 

Scotland 

Directions to 

Importance of. 
Sep 
Nursing, Journal 

Ochre Yrllow S *>on 

on 



358 



INDEX. 



Ochre Yellow Stools, Harley on. . . 13 

Occipital Headache . . 235 

Oglesby, Dr. R. P., Report of 

Epidemic at Leeds, England 286 
Ohio State Medical Society . . .63, 105 

Papers read at, 1894 91 

Paper read at, Columbus, 1895. 149 

Discussion in 107 

Exhibition of Specimens in . . . 202 

Oleum Eucalyptus. 311 

Olive Oil 321 

"On the Continued Fevers of Great 

Britain, " Quotation froml2. . 15 
Onset of Fever, Condition of Pa- 
tient at, by Murchison 11 

by Hutchinson 12 

by Harley 13 

Operation in Perforation 330 

Ophthalmoscopic Examination of 

the Eye 252 

Opisthotonos in Children 318 

Opium 98, 300, 311 

Ortygia, Island of, Ancient Water 

Supply in 280 

Orphan Asylum, England, Epi- 
demic in 25 

Osier, Reports on Age in Typhoid . 24 
on Incurability of Typhoid 

Fever , 66, 104 

on Mistakes in Diagnosis 74 

on Rose Spots 229 

on Typhoid Fever in Children. 134 

on Temperature 230, 231 

on Differential Diagnosis 262 

on Cost of Typhoid Fever 275 

on the Brand Method 313 

on Relapses 328 

Oysters as an Exciting Cause of 

Typhoid Fever 26 

Outbreaks of Typhoid Fever, Re- 
ports of Mr. Ernest Hart. . . 266 
Caused by Polluted Wells .... 268 
*' Sewage Contamin- 
ated Rivers 267 

Caused by Water Services 
from Manured Fields 270 



Outbreaks of Typhoid Fever, 

Caused by Sewage of Villages. 270 
Pollution of Water- 
gathering Grounds 270 

Caused by Careless Laying of 

Watermains 270 

Caused by Contaminated Milk. 86 

". Paludism, " by Laveran , 243 

Palustral Blood 243 

Papular Rash 147 

Paraffin 246 

Paralysis 308 

" Parasites of Malaria," by Mar- 

chiafava and Bignmi 243 

in Palustral Blood 243 

Paris, Water supply of 282 

Death Rate, in 278 

Parke Davis and Company 132 

Paroxysms of Malaria 244 

Pathological Changes in Typhoid 

Fever 14 

Patient, Care of 296 

Pennsylvania Hospital, Reports of 

Health 315 

Pepper's " System of Medicine". . . 134 

on Temperature. 230 

on Diagnosis 258, 263 

Peptonized Milk, 312 

Pfieffer, on Pathogenesis of the 
Pettenkofer, on Oscillations in 

Water in Wells 289 

Bacillus Typhosis 

Perforation 14, 217 

Report of Death from 256 

Cause of Death. 257 

Danger to be Avoided 307 

Danger of 312 

to Minimize the Danger of . . . . 181 

Danger from Peristalsis 320 

Treatment of 329 

Ricketts on 320 

Operations in 331 

Period of Incubation '. 26 

Peristalsis Intestinal 320 

Peritonitis 14, 257 



INDEX. 






Pernicious Malarial Fever, with 

Coma 

Peroxide of hydrogen 

Perspiration, Microsc o p i c a 1 Ex- 
amination of 

Petit (1813), Fievre entero-mesen- 

terique 

Peyer's Glands.. 14, 217, 306, 313 
Date of appearance of lesions 

Lesions in infants 

Cicatrizing Ulcers of, Evidence 
of Effect of Abortive Treat- 
ment 152, 153, 154, 155 

Colored Plate of Cicatrizing 
Ulcers of, No.l, facing page 

Lesions of 

Condition of, in Hypothetical 

cases 300, 

Ulceration and Perforation of 
Elevation of Temperature Ac- 
credited to Ulceration of . . , 

Sloughs of, in Stools 

Early Ulceration of 236, 

Reported Death from Perfo- 
ration 

Danger of Perforation of, in 

Mild Cases 

Grave Lesions of, infrequent 

in Children 

Cicatrizing Ulcers Exhibited 

Diet in, Ulceration of 

Case of Perforation of Ulcer 

of, Reported 

Pharmaceutical Era, Dr. V. C. 
Vaughn, on Typhoid Fever 

in the United States 

Philadelphia, Death Rate in. .277, 

German Hospital Reports 

Phosphates, Triple in Stools 

Phthisis Pulmonaris, Acute, Dif- 
ferential Diagnosis of 

Picric Acid 

Pigment Globules in Leucocytes. . 

Pinel (1798), Fievre ataxique pro 

parte, Fievre adena menin- 

gee 



249 
330 

223 

18 
329 
237 

61 



5, 159 



152 
14 

313 

329 

158 
234 
205 

25G 

257 

316 
202 
323 

183 



101 

27!) 
311 
234 



217 



16 



Piorry(1841) Entente Septicemique 

Pittsburg, Death Rate in 

Cases of Typhoid Fever in. . . 
Pittsburg Dispatch, Report of 

Health Returns 

Pituitous Fever, Copland (1814).. 

Plasmodia Malariae, stain for 

Plaster, Adhesive 

Plymouth, Penn., Epidemic of Ty- 
phoid at 

Pneumonia, Initial Treatment, 

Abortive 

Differential Diagnosis of. . 137, 

Reported Death from 

Antiseptic Treatment of 

Complicating Typhoid 

Treated as Typhoid 

Treatment of 

Dr. Dickson's Case of 

Pneumo-typhus, Case of 

Dr. Dodge's Case 

Differential Diagnosis of 

Treatment of 

Podophyllum Resin, in Formula 

No. 1 

in Formula No. 2 

in Formula No. 4 

Poisonous Effluvia, as a IV 
posing Cause of Ty; 

Fever 

Portugal, Death of King of . . 

Post-Mortems 

by Osier 

by Dr. Dodge 

Revealing Cicatri/i: 
Aborted 
Potash, Chlor it< 

l'otass acetate 

Poultice, in Peri 
Powell and 1- 

for M 
Pragu<\ I 

I 

■nancy, Compli- 

t 



16 
278 
271 



878 

17 
845 

311 

889 
131 

151 

218 
307 
300 
308 

115 



BOfl 






3G0 



INDEX. 



Presbyterian Hospital, Health Re- 
ports of 315 

Prescriptions, Formula No. 1 302 

Formula No. 2 303 

Formula No. 3 305 

Formula No. 4 321 

Formula No. 5 321 

Diuretic 300 

Prestwich, Professor, on Drainage 

from Graveyards. ... 289 

Previous attacks of Typhoid, Im- 
munity given by 25 

Priestly, Dr 289 

Prince Consort, Report of Illness 

and Death of the 258 

"Principles and Practice," Osier's 

Quotation from 234 

Pringle (1750), Bilious Fever, Mili- 
ary Fever 17 

Privies, Outside, Condemnation of 268 
Prodromata of Typhoid Fever. . . . 187 

Prognosis 264 

Prophylaxis 266 

Prostration of Patient During Ty- 
phoid, Murchison on 11 

Hutchinson on 12 

Pseudo-pneumonia, Differential Di- 
agnosis of 308 

Ptomaines 14 

of Bacteria , 292 

Public Health, Department of 274, 283 

Secretary of 274, 283 

Puerperal Fever, Differential Diag- 
nosis of 252 

Pulmonary Complications, Harley 

on 13 

Pulmonary Artery 309 

Pulmonary Phthisis, Journal of the 
American Medical Associa- 
tion on 29 

Pulse, in Murchison's Definition of 

Typhoid Fever 11, 240 

in Hutchinson's 12 

Louis on 240 

Good During Antiseptic Treat- 
ment 213 



Pulse, as an Aid to Early Diagnosis, 239 
Period of Greatest Accelera- 
tion 255 

Range in Hypothetical Case. . 256 

Period of Greatest Weakness. 257 

Dicrotic 309 

Frequency in Children , 313 

in Relapse 325 

Pupils, Dilated, Murchison on. . . . 11 

Pus, in Perforation 330 

Pyaemia, Differential Diagnosis of . 252 

Pyogenic Surface 15 

Condition of 154 

Pyrexia 311 

Harley on 13 

Pythogenic Fever, Murchison 

(1858) 18 

Quartan Ague 244, 248 

Quesnay (1753), Febris Stercoralis 17 

Quinine 89, 151, 164, 184 

as Destructive of Haematozoa 

Malarise 219 

in Malarial Fever 225 

as a Tonic .299, 311 

Quotidian Ague 244 

Rales in Reported Case of Pneu- 
monia 163 

Recklinhauser 224 

Record, Clinical 297 

Rectum, Normal Temperature in. . 232 
Reed, Dr. T. F., Report of Cases. 164 

Cases Aborted 220 

Registrar of Pittsburg, Reports of. 278 

Relapses 325 

Hutchinson on 12 

Report of Cases of 59, 78, 326 

Murchison on 12 

Percentage of, in the Child. . . 328 
in the London fever Hospital. 328 

in Johns Hopkins 328 

of Hutchinson 328 

of the German Observers, Lei- 
bermiester in Basle, Ger- 
hart, Baumler and Biermer. 328 



INDEX. 



361 



Relapses, Dr. Udell's relapse 188 

Dr. Sherman on , . 191 

Dr. Burt on 199 

Remedies, antiseptic, condemnation 

of , 39 

in modified form 191 

Remittent fever 248 

T. Sutton (1806) 16 

Renal Complications 235, 306 

Pathology of 262 

Renfrew, England, epidemic in... 275 

Reports of Cases of Typhoid Fever 
treated by Woodbridge Meth- 
od in Youngstown .... 35, 49, 
54, 76, 77, 88, 113, 138, 196, 208 

in Ironwood, Michigan 44 

in Trumbull County. 96 

in Sewickley, Penn 151 

by Dr. Cunningham 151 

by Dr. Reed.. 164 

by Dr. Justice 162 

by Dr. Dickson 164 

by Dr. March 166 

by Dr. Dodge 183 

by Dr. Udell 185 

by Dr. Chritzman 188 

by Dr. Balmer 190 

by Dr. Sherman 191 

by Dr. Law... 192 

by Dr. McGarvey 194 

by Dr. Yost 195 

by Dr. Shields 195 

by Dr. Burt 197 

Report of deaths 182 

by Murchison, Stoll and Bou- 

det 286 

my last 138 

Report of Long Continued Case 208 

unusually High Temperature. . 230 

Respirations 240 

Respiratory organs, Niemeyeron.. 317 

Rest in typhoid, Journal of the A. 

M. A. on 30, 31 

Essential and when 307, 312 

in Inflammation 

in Pregnancy 334 



Retching ?1 

Reynolds' "System of Medicine," 
Quotation on Typhoid in 

Children 130 

Rhagades 317 

Rheumatism, High Temperature 

in 

Rice, Infusion of 

Richie (1846), Enteric Fever . . .18 
Ricketts, Dr. Merrill, on Typhoid 

Ulcer and Perforation 330 

Richter (1813), Gastrisches Fie- 

ber 17 

Riedel (1748) Febris Intestinalis 

vel Mesenterica 17 

Rigors, Murchison on 11 

Hutchinson on 12 

Ring Cushion 311 

Riverius (1623), Febris Putrida, 

Febris Biliosa 16 

Rivers, Pollution of '-• 

Contaminated 

Pure Water in. B71 

Roast Beef 

Roman Syndic, Laws of 

Rome, Ancient Water Supply ci 

Protection of Milk in 

Death Rate in 

Rose Shaped Bodies in Palustral 

Blood 

Rose Spots 

Co-existence ol 

Scarlatina with. . . . 
Pathognomonic 

Osier on 

Murchison on Lfl 

Surgeon General u.iur.'- 
Huti binaoo on .... 

Louis on 

Harley i 
in Childi 
in I. 

Cot 



362 



INDEX, 



Rose Spots, Diagnostic Value of. . 251 

Rotterdam, Death Rate in 278 

Routine Treatment of Typhoid, 

Journal of A. M. A. on 30 

Rubeola 300, 316 

Rural Districts, Disposal of filth in 267 

Typhoid the Bane of 275 

Danger of Polluting Water of 284 
Rutty, (1790) Bilious Fever 17 

Saint Louis Hospital 200 

Saint Petersburg, Death Rate in. . 278 
Saline Cathartics, Condemnation of 210 

Advised 306 

Saline Infusion, in Vein in Perfo- 
ration 330 

Sandhurst .... 260 

Sanitary Authorities 272 

Sanitary Era, on Epidemics of Ty- 
phoid Fever 287 

Sanitary Science, Importance of. . 283 
Sarcone (1765) Febris Glutinosa 

Gastrica 17 

Sauvages (1760) Typhus Nervosa, 
Typhus Hysterica Vermino- 

sus 15, 18 

Scarlatina 148, 218, 290, 300 

Differential Diagnosis of 250 

Complicating Typhoid 316 

Schleimfieber, Kanz (1795) 17 

Schonlein (1839) Typhus Gangliar- 

is vel Entericus 15 

Scotland, Typhoid Fever in 277 

Secretary of Public Health; 274 

Sedative, Nervous, Alcohol as a. . . 300 
Segmented Bodies in Palustral 

Blood 243 

Seine, River 282 

Selle (1770), Febris Atacta Pro 

Parte 16 

Febris Biliosa Putrida 17 

Febris Nervosa Febris Ver- 

minosa 18 

Selinus, Water Supply of 280 

Semmola, Quotation from 3 

Senn, on Operation in Perforation 331 



Sepimia, Hare (1853) 16 

Sequelae, of Typhoid Fever 14, 329 

Dangerous 241 

Serres (1813), Fievre Entero-mes- 

enterique 

Sero-therapy 259 

Sewage as Cow's Food 266 

Sewers 25, 272 

in Washington 269 

in Vienna 272 

Sherman, Dr. W. N., Report of 

cases : 191 

Shields, Dr. W. B., Report of 

Cases 195 

Sick Room, Proper Condition of. . 295 

Sinapism 303, 318 

Skin, Murchison on Condition of. . 11 

Condition 256 

Care of 296 

Application of Guaiacol to 322 

Sleep, Natural During Abortive 

Treatment 213 

of Health 217 

Frequent Dosage not Destruc- 
tive of 302, 304 

Slow Fever, Strother (1729), Lang- 

rish (1735) 16 

Slow Nervous Fever, Huxham 

(1739) 16 

Smallpox, Less to be Dreaded than 

Typhoid Fever 101 

Amenable to Antiseptic Treat- 
ment 218 

Smith, Greig, on Operation in Per- 
foration 331 

Smith. Southwood (1830), Syno- 
chus and Typhus with Ab- 
dominal Affection. 15 

Sodium Nitrate 235 

Soil, Natural Habitat of Typhoid 

Bacillus 267 

Sokolof 224 

Solid Food.35, 70, 95, 174, 189, 197, 313 
Solitary Glands of Peyer, Harley 

on 12 

Tumefaction of 14 



INDEX. 



363 



Solutions, Disinfectant, 

of Eosin 

of Methylene Blue 

Chlorate of Potash, Saturated. 
Somerville, Mass., Epidemic of 

Typhoid in 

Sordes, a Symptom of Typhoid. . . 
240, 

in Children 

Specific Infection 

Spherical Bodies in Palustral 

Blood 

Spigelius, (1624) Febris Semi-terti- 

ana Seu Composita 

Spleen, Dullness Over 75, 

Murchison on 

Hutchinson on 

Enlargement of 

Enlarged 

Invasion of the, by Haematozoa 
Malarias 

Enlargement of, a Diagnostic 
Sign.. 

Dullness in Typical Case 

Tumefaction of 

Spiritus Nitri Dulcis 

SpiritusTerebinthinae 

Sponging 71, 104, 

Journal of the A. M. A. on. . . 

in ordinary Cases 

Directions to Nurses, in Re- 
gard to 

in Children 

Springfield, Mass., Epidemic of 

Typhoid at 

Sputa, Microscopical Examination 

of 

Stahl (1700) Febris Biliosa 

Stamford, Conn., Epidemic at 

Sternberg 

Stewart (1840) Typhoid Fever.... 

Stewart, Dr. H. T 

Stimulants 

Stockholm, Death Rate in 

Stoll (1785) Febris Pituitosa 



284 
245 
245 
308 

287 

257 
317 
178 

243 

16 
88 
11 
12 
99 
217 

219 

234 
257 
316 
306 
311 
296 
31 
95 

311 
322 

287 

223 

17 
278 
2 'J I 

15 

117 
B08 

17 



Stoll, on Haemorrhage and Ulcera- 
tion 

Stomach, Journal of the A. M. A. 
on Treatment of, during Ty- 
phoid Fever 31 

Free Action of 

Stools, Alkaline 884 

Condition of, Value as a Symp- 
tom 234 

Microscopical Examination i : 

Disinfection of 

Loss of Offensive Odor 

Ochre Yellow, of Hutchin- 
son 13, 834 

Strack (1789) Febris Pituitosa ... . 17 
Strength Impaired by Typhoid 

Fever 

Journal of the A. M. A. on . . . 80 

Strother (1729) Slow Fever lfl 

Strychnine, in Flagging Heart. 

in Perforation 

in Haemorrhage 

Stupor, Murchison on, 11 

Hutchinson on 12 

Styrian Alps, water of 

Sudamina 1 W 

Sulphanilic Acid 

Sulphate of Magnesia 191 

Sulphites 210 

Sunstroke, Differential : 
Surgery, in Perforation. ... 
Sutherland, Mr., on Cosl ol 

phoid Fiver in Great Brit- 
ain 

on Cost of Typhoid 

Scotland 

on Death Rate In E 
;:. Bland, 

■ 
Sutton T ' : W 

lfl 

Fevc; 
Symptomatology 7() . *** 



364 



INDEX. 



Symptomatology, Rose spots, 61, 
75, 88, 99, 227, 228, 229, 250, 

251, 256, 276, 319 325 

Temperature, 12, 30, 35, 70, 

129, 148, 158, 198, 201, 211, 

213, 214, 217, 229, 230, 231, 

232, 246, 255, 256, 298, 299, 

310, 319, 320, 322, 325. 

Meteorism 233 

Tympanites 

11, 13, 65, 213, 217, 233, 256, 316 
Abnormal Tenderness or Pain 

11, 12, 232, 233, 256 

Gurgling 11, 233, 256 

Enlargement of Spleen 

99, 217, 234 

Diarrhoea 213, 

234, 256, 257, 300, 304, 311, 321 

Urine 234, 256, 283, 306 

Renal Complications 235, 306 

Intestinal Haemorrhage 

...66, 76, 130, 140, 181, 198, 

217, 235, 307, 312, 318, 320, 332 

Headache 238, 256, 318 

Vertigo 238 

Chilliness 11, 12 

Epistaxis 238, 318 

Pulse 213, 

239, 255, 256, 257, 309, 318, 325 

Respirations 240 

Heart 240, 307, 308, 311 

Vomiting... 240, 256, 303, 318, 335 

Nausea 235, 240 

Retching 240 

Hebetude 241 

Delirium 

213, 217, 241, 256, 257, 318 

Peyer's Glands, Lesions of. . . 
14, 154. 155, 

156, 158, 202, 217, 236, 237, 

256, 257, 265. 306, 313, 323, 329 

Sloughs from 234 

Opisthotonos 318 

Symptoms of Typhoid Fever, by 

Murchison ... 11 

by Hutchinson 12 



Symptoms of Typhoid Fever, 

by Harley 13 

Control of 35 

Synochus, Southwood Smith (1830) 15 

Biliosus. Sauvages (1760) 17 

Pro parte, Cullen (1796) 15 

Synonyms of Typhoid Fever, by 

Murchison 15 

Synopsis, of Cases. . .204, 207, 230, 325 

"System of Medicine," by Rey- 
nolds 134 

by Pepper 134 

Tablets Formula No. 1 302 

Formula No. 2 303 

Formula No. 4, (for Children). 321 
Directions for Administration 

of 302, 303, 

304, 305, 307, 310, 313, 320, 321 

Wyeth's Bronchitis 89 

Taches, Roses Lenticulaires of 

Louis 227 

Taylor on Operation in Perforation 331 
Teething, Differential Diagnosis of 137 

Temperature 35, 129, 210, 298, 299 

Typical, Chart of Wunderlich 217 

of Sick Room 319 

not a Measure of Danger 70 

Case with High, Treated as a 

Case of Indigestion 148 

Ulceration of Peyer's Glands 

not a Cause of Elevation of. 158 
High, in Cases Reported by 

Dr. Burt ~ 198 

Typical, in Cases Reported by 

Dr. Dalton... 201 

Report of Case of Unusually 

High 211 

Lower During Abortive Treat- 
ment 213 

in Diagnosis 229 

in Rectum 232 

Slight Elevation, a Symptom 

of Typhoid 255 

Exacerbation of 256 

in Children 322 



INDEX. 



365 



Temperature, Journal of the A. M. 

A., on 30 

Osier on 230, 231 

Hutchinson on 12 

in Relapse 325 

of Bath 320 

of Disinfecting Solution 319 

of Incubator 246 

After Application of Guaiacol. . 322 

in Children 133 

Terebinthinae Spiritus 311 

Tertian Ague 244, 248 

Test, Diazo, of Ehrlich 235 

Therapeutic Agents 299 

The Hague, Death Rate in 278 

Theory of Typhoid Fever 188 

Thermometer, Clinical 229 

Thin, Dr. George, Quotations from 

Article in London Lancet. . . 249 
on Dye for Staining Parasites 

of Malaria 245 

on Microscopical Examination 

of Palustral Blood 247 

on the Microscope in Diagnosis 249 

Thomas, Dr. J. J 51 

Thoracic Region 311 

Thrombosis, Venous, Treatment of 309 

Thymol, in Formula No. 2 303 

in Formula No. 3 305 

in Formula No. 5 321 

Tissot, (1758), Febris Putrida aut 

biliosa 16 

Toast Water 324 

Tongue, Parched 217 

Murchison on 1 1 

in Diagnosis 240 

Condition of, as a Symptom. . . 256 

Condition of 257 

in Infants 318 

Towns, Sanitation in 268, 272 

Toxaemia in Hypothetical Case 312 

Tox-albumen 292 

Toxicologists 218 

Toxins 14, 292 

Tralliani, A. (1785), Febris a Putri- 



dine Orta. Typhus Hyster- 

ico Verminosus 

Treatment of Typhoid Fever, Mod- 
ifying Effect of . . . . 

Typhoid Amenable to 

Unscientific 

Action of Antiseptics in 

Abortive 114, 12fl 

in all Stages of Typhoid 

Antiseptic 

Under Mistaken Diagnosis. . . . 

Abortive, Endorsement of, 
vidi Abortive 

Salines in 

in Hospital Wards with Other 
Diseases 

Efficacious 

of Typhoid in Children. . .810, 

in Relapses 

Complicated with Pregnancy. . 

Trieste, Death Rate in 

Tritaeophyas, Auctor Antiq. Y.tr. . 
Tritaeophya Typhodes, Mangetus 

(1695) 

Tubercle of the Choroid 

Tubercular Meningitis, Dii! 

tial Diagnosis of 

Tubercular, Differential Diag- 
nosis of 

Miliary 

Microscopical Examination in 
Tumefaction of the Glands 

of the Spleen 

Tumefied Mesenteric 

Turin, Death Kate in 

Turpentine 191 

Emulsion of 

Tympanites, M 

Harley on 

A Diagnostic Sign . 

Minified bj PtU 

Treatment 

in Hypothetic el Case ■ . 
in Cnildi 
Typhi:., Parr, (U 



16 

184 

81 

104 

110 

131 
1 82 

136 



211 
298 
Blfl 

16 

IN 

1 1 

11 



366 



INDEX. 



Typhoid Fever 11 

Stewart, (1840), Bartlett, 

(1842), Jenner (1849) 15 

Typhoid Fever, Insidiousness of 

Attack 241 

Typhoid State 250 

Typhoid Ulcer 330 

Typho Toxin 292 

Isolated by Brieger 324 

Typho-malarial Fever 72, 99 

Woodward (1863) 20 

Condemnation of Application 
of Designation to Typhoid. . 66 

Dr. Eliot, on 73 

Typhus 15 

Differential Diagnosis 249 

Isolated 290 

Spots of, contrasted with Rose 

Spots 250 

Typhus Gangliaris, vel Entericus 

Ebel (1836), Schonlein (1839) 15 
Typhus Mitior, Cullen (1769) 15 

Udell Dr., Reports of Cases. . .124, 145 

Communication from 185 

Ulcer „ 236 

Typhoid, Rickets on 330 

Murchison on 226 

United States, Health Departments 

of Cities in 41 

Death Rate in 101, 114 

Benefit of Abortive Treatment 

to 200 

Report to House of Representa- 
tives of 269 

Need of Bureau of Public 

Health in 274 

Demand for Secretary of Public 

Health in 274 

Urine, Microscopical Examination 

of 223 

in Diagnosis 234 

Scanty 256 

Disinfection of 283 

Dilution of 306 

Hy pertoxic 234 



Van Hook, on Operation in Per- 
foration 330 

Report of Case 331 

Vapours, Manningham (1746) 16 

Varieties of Typhoid Fever 319 

Variola 72 

Differential Diagnosis of 253 

Vaughn, Dr. Victor C, Estimate of 
Loss to the United States, from 

Typhoid Fever 201 

Vegetable Cathartics, use of, Con- 
demned by Harley 210 

Venice, Death Rate in 278 

Venous Thrombosis, Treatment of, 309 

Vertigo, in Diagnosis 238 

Via Appia 280 

Victoria, Queen, Diary of 259, 260 

Vienna, Death Rate in 278 

Water Supply of 269 

Virchow 203 

Virus, Waterborne 25 

Viscera, Abdominal 295 

Vogel, (1764) Febris Lenta 16 

Vomit, Disinfection of 283 

Vomiting, in Diagnosis 240 

in Hypothetical Case 256 

Treatmeut of 303 

in Children 318 

Harley on 13 

Von Gietl, Definition of Typhoid. . 13 
Vyrnwy River, Water Supply 

from 282 

Wales, Prince of, Illness of 261 

Wampum, Penn., Epidemic of Ty- 
phoid at 36 

Ware, Dr. John D 41, 42, 43 

Washington, Infected Wells of 269 

Water, Impure, Tolerance of . ... 23 

Contaminated 24 

Boiling of '. . . . 25 

Journal of A. M. A. on 31 

Nonpotable, Effect of 86 

as a Therapeutic Agent 104 

as a Cause of Outbreaks of Ty- 
phoid Fever 266 



INDEX. 






Water as a Disinfectant 

Pollution of 288, 

Warm Salt 

Administration of 

Large Draughts of 

Cooling Effect of 

Distilled 235, 245,247, 

Mineral 191, 303, 

Charged With Carbonic Acid 
Gas..... 

for Children 

Sterilized 

Lime 

Toast 

Diuretic Mineral 

Bed , 

"Water Borne Typhoid," by Mr. 
Ernest Hart, Report on. . . . 

24, 26,266, 

Water Borne Virus 

Waterbury, Conn., Epidemic of 

Typhoid at 

Watertown, New York, Epidemic 

of Typhoid at 

Water Supply 

In the District of Columbia, 

in Vienna 269, 

in Magara 

in the Island of Cos 

in Athens 

in Selinus, Sicily 

in Syracuse, Sicily 

on the Island of Ortygia 

in Rome 

in Marseilles 

in Bengal, India 

in Manchester 

in Glasgow 

in Liverpool. 

in Paris 

Watson, Sir Thomas, Report of 

Case 

Well Water 

Pollution of 

Mr. Ernest Hart on 



2S4 
291 
330 
296 
302 
299 
303 
306 

303 
321 
303 
328 
324 
303 
311 



270 
25 

289 

289 

27 
269 
282 
280 
280 
280 
280 
280 
280 
280 
2S2 
282 

382 

2G1 

268 

270 



Well Water, Infected, Typhoid 

Propagated by 

Pollution of Milk by 387 

Oscillation of 

Welphy, Dr., "Creameries and In- 
fectious Diseases, " Quotation 
from 286 

Wendt (1812), Febris Mesaraica.. . 18 

West Baden Mineral Springs, Meet- 
ing of Mitchell District Med- 
ical Society at 

West Branch Medical Society, 

Cases Reported at 190 

Whiskey 183 

Whitesfield, Epidemic of Typhoid 
at 

Whooping Cough Complicating Ty- 
phoid Fever 14o 

Wickham, Dr., Diagnosis made by 36 

Willis, (1659) Febris Lenta, Febris 
Putrida Quae Vulgo Lenta 
Appellatur, Febris Hectica 
16, IS 

Wilson, on Treatment of Typhoid 

Fever 

on Brand Method 81! 

Report of Cases 

on Bronchial Catarrh -17 

Winnifrede, West Virginia, B 

demic of Typhoid at 

Wintringham, | [1 1 I 'utri- 

da Nervosa 16 

Wood (1848), Enteric Fever 18 

Woodbridge, Profess r, L D 

La 

on Bronchial Catarrh 'Ml 

Woodbridge, Dr. Til 



on M.ili: 
Iward, Snt 

20 
Worms, Typhoi 

ly I 
Won:: "M* 

Writeri 



368 



INDEX. 



Wunderlich 232 

Chart of 216 

Reference to Chart 229, 284 

Wyeth's Bronchitis Tablets 89 

Xylol 248 

Youngstown 107 

Health Reports of 73 



Youngstown, Cases of Typhoid Fev- 
er Treated in, vide reports 

Yost, Dr. J. O., Report of Cases. . 

126, 294 

Zincum Chloridum 284 

Zymotic Affections, Treatment of . 219 
Zymotic Diseases, Antiseptic Treat- 
ment of 221 



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